Implementation Guidelines for Total Hip and Total Knee Arthroplasty to Reduce the Incidence of Deep Vein Thrombosis and Subsequent Pulmonary Embolism

With patients living longer, the orthopedic sector has given rise to joint prostheses as a treatment for those experiencing osteoarthritis (OA). With the increase of these procedures, there is also an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus (PE) following these surgical procedures. The orthopedic medical community and anesthesia providers aim to decrease DVT and PE risk through multiple modalities. The anesthesia focuses on reducing DVT, and PE involves a multimodal approach to each anesthetic. Modalities used for the multimodal approach involve peripheral nerve blocks (PNB), neuraxial spinal anesthesia, early mobilization, postoperative nausea and vomiting (PONV) reduction, and tranexamic acid to prevent bleeding during these procedures. This study's research has concluded that tranexamic acid does not increase the risk of DVT following total hip (THA) or total knee arthroplasty (TKA) in appropriate populations. Muscle-sparing PNB or spinal anesthetics allow for earlier ambulation in THA and TKA patients. A multimodal approach to PONV allows patients to mobilize faster and allows a short post-anesthetic care unit (PACU) stay. Combined and coupled with educating the patient on the importance of early mobilization participation, it decreases the risk of DVT and PE following THA and TKA.