Lieberman JR, Huo MM, Hanway J, Salvati EA, Sculco TP, Sharrock NE.
The prevalence of deep venous thrombosis after total hip arthroplasty with
hypotensive epidural anesthesia.
J Bone Surg Am 1994 Mar;76(3):341-8

Hospital for Special Surgery, New York, NY 10021.

A prospective, randomized trial was done to evaluate the prevalence of deep
venous thrombosis following primary unilateral or bilateral total hip
arthroplasty with use of hypotensive epidural anesthesia, external
pneumatic-compression boots, and aspirin (Group I) and with use of hypotensive
epidural anesthesia and aspirin (Group II). All operations were performed by two
of us (E. A. S. and T. P. S.) through a posterolateral approach. Two hundred and
thirty-one patients who were more than thirty-nine years old and who had a total
of 250 primary total hip arthroplasties were included in the study. There were
113 patients (124 hips) in Group I and 118 patients (126 hips) in Group II. All
patients had venography on the sixth, seventh, or eighth postoperative day. Group
I had no proximal thrombi, seven distal thrombi (6 per cent), and one late
pulmonary embolus (1 per cent). Group II had one proximal thrombus (popliteal) (1
per cent), eight distal thrombi (6 per cent), and one late pulmonary embolus (1
per cent). The difference was not significant (p = 0.65). However, a significant
difference may have been noted if the study population had been larger. The
combination of hypotensive epidural anesthesia and aspirin is effective
prophylaxis against deep venous thrombosis in patients who have a primary total
hip arthroplasty. The extremely low rate of deep venous thrombosis in the present
study may be attributed to the use of hypotensive epidural anesthesia and the
associated decrease in blood loss and transfusion requirements.(ABSTRACT
TRUNCATED AT 250 WORDS)