Total Hip Arthroplasty in Patients with Coagulopathy

Philipp von Roth; Kathi Thiele

doi:10.1055/a-0902-5362

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2020; 158(02): 165-169
DOI: 10.1055/a-0902-5362

Review/Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Total Hip Arthroplasty in Patients with Coagulopathy

Article in several languages: English | deutsch

Authors

Philipp von Roth

¹Endoprothetik, Sporthopaedicum, Straubing
Kathi Thiele

²Centrum für Muskuloskeletale Chirurgie, Orthopädische Universitätsklinik der Charité, Berlin

Abstract

Prior to a surgical intervention, the examination of patient coagulation disorders is unfortunately often underestimated. While patients with a haemophilia A or B are usually aware of the congenital tendency to bleed, disorders of increased blood coagulation, thrombophilia, are frequently undetected. Therefore, complications caused by thromboses and embolisms after total hip arthroplasty are far more common than uncontrollable post-operative bleeding. Patients with liver cirrhosis are considered to be particularly complicated and their coagulation status can be difficult to manage. This article describes the most common pathological coagulation disorders and provides information to identify them preoperatively. Furthermore, surgical strategy considerations for the use of certain implant types in this patient group are discussed.

Key words

coagulopathy - total hip arthroplasty - haemophilia - thrombophilia

Full Text

References

References/Literatur
1 Healy WL, Iorio R, Clair AJ. et al. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by The Hip Society. Clin Orthop Relat Res 2016; 474: 357-364 doi:10.1007/s11999-015-4341-7
2 Schenk JF, Stephan B, Kusma M. et al. [Orthopedic patients with or without thrombophilia. Diagnostic, therapy and peri-operative strategies]. Orthopade 2009; 38: 835-842 doi:10.1007/s00132-009-1455-1
3 Lieberman JR, Cheng V, Cote MP. Pulmonary embolism rates following total hip arthroplasty with prophylactic anticoagulation: some pulmonary emboli cannot be avoided. J Arthroplasty 2017; 32: 980-986 doi:10.1016/j.arth.2016.09.006
4 Alcock RF, Reddel CJ, Pennings GJ. et al. The rebound phenomenon after aspirin cessation: the biochemical evidence. Int J Cardiol 2014; 174: 376-378 doi:10.1016/j.ijcard.2014.03.192
5 Plümer L, Seiffert M, Punke MA. et al. Aspirin before elective surgery – stop or continue? A single-center cross-sectional study. Dtsch Arztebl Int 2017; 114: 473-480 doi:10.3238/arztebl.2017.0473
6 Chechik O, Thein R, Fichman G. et al. The effect of clopidogrel and aspirin on blood loss in hip fracture surgery. Injury 2011; 42: 1277-1282 doi:10.1016/j.injury.2011.01.011
7 Jacob AK, Hurley SP, Loughran SM. et al. Continuing clopidogrel during elective total hip and knee arthroplasty: assessment of bleeding risk and adverse outcomes. J Arthroplasty 2014; 29: 325-328 doi:10.1016/j.arth.2013.06.008
8 Schlitt A, Jámbor C, Spannagl M. et al. Perioperativer Umgang mit Antikoagulanzien und Thrombozytenaggregationshemmern. Dtsch Arztebl Int 2013; 110: 525-532 doi:10.3238/arztebl.2013.0525
9 Schott P. Perioperativer Umgang mit Antikoagulanzien und Thrombozytenaggregationshemmern. Berlin, Heidelberg: Springer; 2016
10 Kapadia BH, Boylan MR, Elmallah RK. et al. Does hemophilia increase the risk of postoperative blood transfusion after lower extremity total joint arthroplasty?. J Arthroplasty 2016; 31: 1578-1582 doi:10.1016/j.arth.2016.01.012
11 Colgan G, Baker JF, Donlon N. et al. Total hip arthroplasty in patients with haemophilia – What are the risks of bleeding in the immediate peri-operative period?. J Orthop 2016; 13: 389-393 doi:10.1016/j.jor.2016.06.022
12 Lim SJ, Yeo I, Park CW. et al. Outcomes of total hip arthroplasty in patients with primary immune thrombocytopenia. BMC Musculoskelet Disord 2015; 16: 278 doi:10.1186/s12891-015-0742-8
13 Hundt G. Gerinnungsstörungen. Heidelberg: Springer; 2012
14 Koscielny J, Ziemer S, Radtke H. et al. A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 2004; 10: 195-204
15 Wu GL, Zhai JL, Feng B. et al. Total hip arthroplasty in hemophilia patients: a mid-term to long-term follow-up. Orthop Surg 2017; 9: 359-364 doi:10.1111/os.12354
16 Carulli C, Felici I, Martini C. et al. Total hip arthroplasty in haemophilic patients with modern cementless implants. J Arthroplasty 2015; 30: 1757-1760 doi:10.1016/j.arth.2015.04.035
17 Lee SH, Rhyu KH, Cho YJ. et al. Cementless total hip arthroplasty for haemophilic arthropathy: follow-up result of more than 10 years. Haemophilia 2015; 21: e54-e58 doi:10.1111/hae.12544
18 Panotopoulos J, Ay C, Schuh R. et al. Comparison of metal on metal versus polyethylene-ceramic bearing in uncemented total hip arthroplasty in patients with haemophilic arthropathy. Int Orthop 2014; 38: 1369-1373 doi:10.1007/s00264-014-2326-x
19 Strauss AC, Rommelspacher Y, Nouri B. et al. Long-term outcome of total hip arthroplasty in patients with haemophilia. Haemophilia 2017; 23: 129-134 doi:10.1111/hae.13045
20 Yoo MC, Cho YJ, Kim KI. et al. The outcome of cementless total hip arthroplasty in haemophilic hip arthropathy. Haemophilia 2009; 15: 766-773
21 Deleuran T, Vilstrup H, Overgaard S. et al. Cirrhosis patients have increased risk of complications after hip or knee arthroplasty. Acta Orthop 2015; 86: 108-113 doi:10.3109/17453674.2014.961397
22 Tiberi 3rd JV, Hansen V, El-Abbadi N. et al. Increased complication rates after hip and knee arthroplasty in patients with cirrhosis of the liver. Clin Orthop Relat Res 2014; 472: 2774-2778 doi:10.1007/s11999-014-3681-z