Thromboembolic Disease Prophylaxis in Total Hip Arthroplasty

We sought to determine if using aspirin and exercise as prophylaxis against thromboembolic disease in patients having total hip arthroplasties would provide results as effective as or better than those reported in the literature using other chemical agents. One thousand eight hundred thirty-five total hip arthroplasties were done in 1585 patients using a posterior approach. Surgery was done with the patient under general anesthesia in 459 instances and regional anesthesia in 1376 instances. Graduated elastic stockings were used in 1117 instances and intermittent compression stockings were used in 718 instances. Passive exercises of the major joints of the operated extremity were done intraoperatively, and active exercises were done postoperatively. Patients received a suppository containing 10 grains of aspirin immediately after surgery and 325 mg twice a day for the length of their hospitalization. Fatal pulmonary embolism developed after two (0.10%) surgical procedures. Nonfatal pulmonary embolisms were diagnosed in 17 (0.9%) patients, and deep venous thrombosis was diagnosed in 17 (0.9%) patients. The low incidence of thromboembolic complications recorded in this series suggests that our postoperative protocol, including 325 mg of aspirin twice a day during hospitalization and exercise, is an effective and inexpensive method of prophylaxis after total hip arthroplasty.

Level of Evidence: Therapeutic study, Level IV (case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.