Prevention of venous thromboembolism in total knee and hip replacement.

Case presentation: A 69-year-old woman had a cemented hip replacement 15 years previously, which initially fared well but then gradually failed because of aseptic loosening. She developed pain in her hip and was scheduled for a revision total hip replacement. A formal venous thromboembolism (VTE) risk assessment was undertaken before surgery according to the Hospital’s policy for all orthopedic admissions. The risk assessment identified 2 conflicting issues. First, the patient had a particularly high risk of VTE, having had an above-knee deep vein thrombosis after her primary hip replacement and now required a major surgery, namely a revision hip arthroplasty. Second, she had a greater than usual risk of bleeding after surgery because of her obesity and the need for a large soft-tissue exposure, long-term aspirin, and supplementary bone graft from her iliac crest. The surgeon was faced with a common orthopedic problem, providing effective VTE prophylaxis without causing an equally important problem of surgical bleeding.