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Dr Kahn is a recipient of a Senior Clinical Research Scientist Award from the Fonds de la Recherche en Santé du Québec and received research funding from the Canadian Institutes

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**1. Introduction** 

**2. Epidemiology** 

surgery (Oster et al., 2004).

**10** 

 *Dallas, Texas* 

*USA* 

**Venous Thromboembolism** 

*University of Texas Southwestern Medical Center,* 

Venous Thromboembolism (VTE) is a common complication following orthopaedic procedures. It is discussed most commonly as it relates to total hip arthroplasty (THA) and total knee arthroplasty (TKA), though this disease process can be seen after any orthopaedic surgery. It is associated with significant morbity and costs (Caprini et al., 2003). This chapter will provide an overview of the epidemiology, pathophysiology, and management of thromboembolic disease. This will include preventative strategies, evidence-based

Total joint arthroplasties remain some of the most common orthopaedic procedures performed worldwide. It is estimated that by 2015, over 500,000 total hip arthroplasties and 1.3 million total knee arthroplasties will be done in the United States alone (Kim, 2008). The aggregate costs in 2007 totaled over \$15 billion (US Agency for Healthcare Research and Quality, 2007). Geerts et al. reported that VTE would occur in 40%-60% of the patients undergoing total joint arthroplasty if no prophylaxis was administered (Geerts et al., 2008). Despite appropriate chemophrophylaxis, one study noted asymptomatic proximal DVT found on ultrasound in 6.7% of THA and TKA patients at the time of transfer to a rehabilitation center (Schellong et al., 2005). As many as 80% of all clinical VTE events associated with arthroplasty patients occur within 3 months after

The costs of VTE are significant. Approximately 10% of the patients who develop VTE following THAs or TKAs require re-admission to the hospital within 3 months after their index surgery (Oster et al., 2004). The clinical sequelae are often significant and can include leg swelling, venous stasis ulcers, pulmonary hypertension, post-thrombotic syndrome, and recurrence (Heit, 2006). The one-year mortality following deep vein thrombosis (DVT) has been reported as high as 14.6%. Pulmonary embolism (PE) is associated with even higher mortality rate. Heit et al. reported as high as 52.3% in a recent cohort study (Heit et al., 1999).

guidelines and a focus on newer drug agents currently being developed.

 **in Orthopaedic Surgery** 

Justin R. Knight and Michael H. Huo

*Department of Orthopaedic Surgery* 

thrombolysis does not always prevent post-thrombotic damage. Eur J Vasc Endovasc Surg 2008; 36: 725-730.

