Complications After Joint Replacement Surgery
What are the risk factors for developing blood clots after joint replacement surgery?
In addition, patients who have high BMI, body mass index, who have history of strokes and atherosclerosis are at increased risk for developing blood clots after joint replacement surgery. In addition, there is a genetic predisposition. Patients with heritable thrombophilia, antithrombin III, protein C deficiency, and prothrombin gene mutation and similar genetic predispositions are at increased risk of developing blood clots after surgery.
Should routine screening be done after joint replacement surgery to detect blood clots?
What are the complications of using very high-potent anticoagulant therapy for preventing blood clots after artificial joint replacement surgery?
What is your preferred method for preventing blood clots after joint replacement surgery?
Additionally, the results have not shown to be very significant and that is something which we do not currently strongly advocate. I therefore do not do preoperative blood donation to lower the hematocrit and decrease the risk of blood clots in every patient undergoing joint replacement surgery.
Surgically, if a cemented prosthesis is used, preheating the prosthesis reduces the curing time and decreases the surgical time and therefore decreases the risk of blood clots. Postoperatively, ankle pumps, which means moving the ankle up and down, keeps the blood moving and improves the femoral vein flow and decreases the risk of blood clots. I recommend continuing these ankle pumps till there is no swelling.
I always ask patients to use elastic stockings after the surgery which has shown to decrease the risk of swelling and blood clots. Additionally, I use calf squeezers to keep the blood moving and that decreases the risk of blood clots after the surgery. I use regional anesthesia, which not only is better for pain control but also decreases the stasis, which again decreases the risk of blood clots. Intraoperatively, I minimize the rotation of the lower extremities so that the blood vessels don’t get kinked and therefore the risk of endothelial injury is reduced.
I also use frequent aspiration of the intramedullary canal and that minimizes the load of procoagulants into the venous saturation. The pharmacologic mainstay for decreasing the risk of blood clots after the surgery is Aspirin.
Why do you use aspirin and not other major potent anticoagulant drugs?
Aspirin also protects against cardiovascular issues and peripheral vascular diseases. In addition, aspirin also can be administered orally. It has immediate action. There is no monitoring required and it is quite inexpensive.
What is Virchow’s triad?
What is the difference between thrombosis and embolism?
What are the symptoms of embolism?
What do you use to prevent blood clots after the surgery?
I do not use any strong anti-coagulants, strong blood thinners for treating or for preventing blood clots, because literature is clear. It has shown that there are a lot of complications associated with them, like bleeding in the joint, bleeding elsewhere, especially in the brain. It is associated with increased morbidity and mortality. I use just aspirin, 325 mg of enteric coated aspirin. That has worked extremely well in my practice. It helps with pain relief and it also decreases the risk of blood clots.
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