Thromboembolism after total hip arthroplasty

Purpose of review: Venous thromboembolism after total hip replacement remains one of the most frequent complications. Controversy exists over which prophylaxis is most effective and safe. Moreover, many orthopedic surgeons have become less aware of its importance because of the very low rate of symptomatic clinical events in their practices. However, it remains one of the potential causes of mortality after elective total hip replacement. This review focuses on some of the most current data on pharmacologic prophylaxis for venous thromboembolism. Recent findings: Routine prophylaxis has been embraced by the majority of American orthopedic surgeons as the standard of care in their communities. The most effective protocols as outlined by the American College of Chest Physicians Guidelines include adjusted-dose warfarin, low-molecular-weight heparin, and factor X_a inhibitor. Increasing evidence-based data support extended prophylaxis for as long as 3 to 4 weeks after surgery. Newer modalities such as oral direct thrombin inhibitors may provide effective alternatives especially in the clinical setting of reduced hospital stay. Summary: It is of paramount importance for orthopedic surgeons to appreciate the clinical relevance of venous thromboembolism after total hip replacement. Existing prophylaxis protocols have effectively reduced both venographic and clinical events.