We have performed one hundred fourteen cases of venogram consecutively after primary uncemented total hip replacement to identify the natural incidence of thromboembolsim in Koreans, the effectiveness of prophylactic regimens such as aspirin,
dextran
and other related findgins.
And we also performed 10 cases of intraoperative venogram to know the relationship between position of hip during operation, velocity of venous flow, and incidence of thromboembolism on the mechanical point of view.
@ES The following results were obtained.
@EN 1. With regard to the incidence of venous thromboembolism, in control group the incidonce was 20%, in Aspirin group the incidence was 11.5% which was decreased in comparison with that of the control group but the difference was not
statistically
significant and in Dextran group the incidence was 5.2% which was not only decreased compared to that of control group, but the difference was also statistically significant.
2. With regard to the distribution of thrombi in patients with venous thromboembolism, in control group the thrombi was present in the iliofemora, distal femoral and major calf veins, but in prophylactic groups with Aspirin and Dextran the
thrombi
was
present in major calf veins, but in prophylactic groups with Aspirin and Dextran the thrombi was presnet in major calf vein and popliteal vein.
3. With regard to the incidence of thrombi located above the knee compared to below the knee according to number of thrombi site, the incidence of thrombi located above the knee which is believed to be related with pulmonary embolism was
relatively
high in control group compared to the prophylactic group, but the difference was not statistically significant.
4. With regard to risk factors influencing the incidence of venous thromboembolism, obesity and long term steroid therapy appeared as significant risk factors. In cases of patients with obesity, even prophylaxis was not effective to reduce the
incidence of venous thromboembolism.
5. laboratory data was not helpful to predict the occurrence of venous thromboembolism.
6. Swelling on entire lower extremity including thigh, leg and foot was a most reliable sign. Pain and tenderness on calf and foot was also a subsequent important sign of venous thromboembolism.
7. In intraoperative venogram, mean velocity of venous flow was 6.9cm/sec, and there was no significiant correlation between the mean velocity of veous flow and incidence of venous thromboembolism.
8. Marked change of venous flow in femoral vein was noticed as mean 40.4° of flexion, 11.5° adduction, and 81.5° of internal rotation of hip. Since complete occlusion of femoral vein with severe kink was found especially in internal rotation
of
hip,
it was desirable to reduce the time of internal rotation during operation.
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