The Journal of Bone and Joint Surgery, Vol 61, Issue 5 653-656, Copyright © 1979 by Journal of Bone and Joint Surgery, Inc
The effect of total hip replacement and general surgery on antithrombin III in relation to venous thrombosis
SN Gitel, EA Salvati, S Wessler, HJ Robinson and MH Worth
This investigation was undertaken to identify and correlate one factor that
makes patients undergoing total hip replacement more susceptible to venous
thrombosis and pulmonary embolism than those who have almost any other
elective orthopaedic procedure, and to determine why the operation of total
hip replacement has proved to be relatively resistant to antithrombotic
prophylaxis compared with general surgical procedures. Using the depletion
of antithrombin III as a marker of activation of the coagulation system,
two groups of patients were compared: twenty-one who were subjected to hip
arthroplasty and fourteen who underwent general surgical procedures. Both
during and after operation the decrease in the quantity of antithrombin III
in hip-arthroplasty patients was significantly greater (p less than 0.05)
than the decrease in general surgical patients. Seventy-three per cent of
hip-replacement patients had venographic evidence of recent thrombosis, 60
per cent of which were discontinuous femoral-vein thrombi. Femoral-vein
thrombosis occurs frequently in hip-arthroplasty patients and is relatively
resistant to current antithrombotic prophylaxis. The data presented suggest
that during hip surgery there is a strong systemic activation of the
clotting cascade that is associated with local vessel injury and local
stasis in the femoral vein, an association not found in most general
surgical procedures.
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