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The Journal of Bone and Joint Surgery, Vol 73, Issue 4 502-506, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty
NE Sharrock, SB Haas, MJ Hargett, B Urquhart, JN Insall and G Scuderi
Department of Anesthesia, Hospital for Special Surgery, New York City, N.Y. 10021.
Epidural anesthesia has been reported to reduce the prevalence of deep-vein
thrombosis after total hip arthroplasty compared with the prevalence after
general anesthesia. However, the effect of epidural anesthesia on the rate
of thrombosis after total knee arthroplasty has not been reported
previously, to our knowledge. A review was conducted of 705 total knee
arthroplasties (541 patients) that had been performed by a single surgeon
between September 1984 and December 1988. During this period, the operative
technique, the protocol for rehabilitation, and the regimen for prophylaxis
against thromboembolism did not change meaningfully. The patients received
either epidural or general anesthesia. Preoperative and postoperative
perfusion scans of the lungs and a venogram of the lower limb or limbs that
had been operated on were done for all patients. For the 227 patients who
had received epidural anesthesia, the over-all rate of deep-vein thrombosis
was 48 per cent, which was significantly lower than the 64 per cent
incidence in the 264 patients who had received general anesthesia (p less
than 0.0001). The greatest reduction was in the occurrence of proximal
thrombosis, which was identified in 9 per cent of the patients who had had
general anesthesia but in only 4 per cent of those who had had epidural
anesthesia (p less than 0.05). The use of epidural anesthesia reduced the
incidence of proximal thrombosis after both unilateral and one-stage
bilateral arthroplasty.
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