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Proximal Deep Vein Thrombosis After Hip Replacement for Oncologic Indications
Saminathan S. Nathan, MD1; Kristy A. Simmons, BA2; Patrick P. Lin, MD3; Lucy E. Hann, MD2; Carol D. Morris, MD2; Edward A. Athanasian, MD2; Patrick J. Boland, MD2; John H. Healey, MD2
1 Musculoskeletal Oncology Service, Department of Orthopaedics, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
2 Orthopaedic Surgery Service, Department of Surgery (K.A.S., C.D.M., E.A.A., P.J.B., and J.H.H.), and Department of Radiology (L.E.H.), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021
3 Division of Surgery, Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, 1515 Holcombe Boulevard, Houston, TX 77030
View Disclosures and Other Information
Read in part at the Annual Meeting of the Musculoskeletal Tumor Society, Long Beach, California, July, 2005.
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Pearlman Limb Preservation Fund and the Biomet Oncology Fellowship. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Memorial Sloan-Kettering Cancer Center, New York, New York

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1066-1070. doi: 10.2106/JBJS.D.02926
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Background: Patients with cancer who undergo surgery about the hip are at increased risk for the development of deep vein thrombosis. We implemented a program of chemical and mechanical prophylaxis to prevent this problem. This study was performed to assess the effectiveness of that program.

Methods: Eighty-seven consecutive patients with an active malignant tumor who underwent hip replacement surgery at our institution over a two-year period were included in the study. All patients were treated with intermittent pneumatic compression devices. Seventy-eight patients received anticoagulants, and nine did not. Postoperative surveillance for proximal deep vein thrombosis was routinely performed on all patients with duplex Doppler ultrasonography.

Results: Four patients had proximal deep vein thrombosis, and one patient, who did not receive anticoagulation, had a nonfatal pulmonary embolism. The use of prophylactic low-molecular-weight heparin (dalteparin) was associated with a 4% rate of proximal deep vein thrombosis (three of seventy-eight patients). Proximal deep vein thrombosis developed in three of eight patients with pelvic disease, one of nineteen patients with femoral disease, and zero of sixty patients with hip disease (p < 0.00001). The prevalence of proximal deep vein thrombosis was significantly higher (p < 0.02) following replacements in patients with sarcoma (three of twenty-one) than it was after replacements in patients with carcinoma (zero of fifty-seven) or hematologic malignant disease (one of nine). On multivariate analysis, only the location of the disease (the pelvis, femur, or hip) was found to be independently significant for an association with deep vein thrombosis. A wound complication developed in four of twenty-one patients with sarcoma and no patient with carcinoma or hematologic malignant disease (p < 0.001). The pathologic type was the only factor studied that was independently significant for an association with wound complications on multivariate analysis.

Conclusions: The rate of proximal deep vein thrombosis in patients who had undergone hip replacement for oncologic indications was low when the use of an intermittent pneumatic compression device was supplemented with prophylaxis with low-molecular-weight heparin.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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