Late deep venous thrombosis and delayed weightbearing after total hip arthroplasty

One hundred ninety-nine patients who underwent primary total hip arthroplas ty and used in hospital pneumatic compression stockings and aspirin as thro mboembolic prophylaxis mere screened for deep venous thrombosis using duple x ultrasonography on the fourth postoperative day. Of the initial 98 patien ts, 21 underwent noncemented arthroplasty, maintained touchdown weightbeari ng for 6 weeks after surgery, and then began progressive partial weightbear ing, Of the subsequent 101 patients, 28 underwent noncemented arthroplasty and began progressive weightbearing immediately after surgery. All other pa tients underwent hybrid arthroplasty and began weightbearing to tolerance i mmediately after surgery. After duplex screening examination, patients with proximal deep venous thrombosis were given anticoagulation therapy, and pa tients with negative study results were observed clinically. The relative r isk of proximal deep venous thrombosis after noncemented arthroplasty using delayed weightbearing was compared with that after noncemented arthroplast y using immediate progressive weightbearing. Of patients with noncemented a rthroplasty, the prevalence of proximal deep venous thrombosis was signific antly lower in those using progressive weightbearing immediately after surg ery (none) than in those using delayed weightbearing rehabilitation (19%). This study showed that patients undergoing noncemented total hip arthroplas ty with delayed weightbearing rehabilitation risk greater potential for dee p venous thrombosis after hospital discharge. This study suggests considera tion for continued thromboembolic prophylaxis or routine deep venous thromb osis surveillance, or both measures, after hospital discharge, unless more rapid progression of weightbearing is allowed.