DVT–Pulmonary Embolism after Major Orthopaedic Surgery / Injury
DNB Orthopaedics • October 2024 • Paper I • 10 Marks
Introduction
Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Major orthopaedic trauma and procedures such as total hip arthroplasty, total knee arthroplasty and hip-fracture surgery are among the clinical settings with substantial VTE risk because they combine venous stasis, endothelial injury and a postoperative hypercoagulable state.
Core pathogenetic concept
The pathogenesis is best understood by Virchow's triad: venous stasis + endothelial injury + hypercoagulability.
Definitions
Deep Vein Thrombosis
Formation of a thrombus within the deep venous system, usually of the lower limb or pelvis.
Pulmonary Embolism
Obstruction of the pulmonary arterial circulation by embolic material, most commonly a thrombus originating from the deep veins of the lower limb or pelvis.
Pathogenesis of DVT after Orthopaedic Surgery / Injury
Virchow's Triad
| Component | Orthopaedic Mechanism |
|---|---|
| Venous stasis | Immobility, limb swelling, bed rest, anaesthesia, postoperative pain, muscle-pump inactivity and tourniquet use |
| Endothelial injury | Trauma, surgery, vessel manipulation, fracture, intramedullary instrumentation and local inflammatory injury |
| Hypercoagulability | Tissue-factor release, inflammatory cytokines, activation of coagulation and postoperative suppression of fibrinolysis |