Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts
Raju Easwaran
(1)
,
Moin Khan
(2)
,
Parag Sancheti
(3)
,
Ashok Shyam
(4)
,
Mohit Bhandari
(2)
,
Anil S. Ranawat
(5)
,
Savyasachi Thakkar
(6)
,
Shital Parikh
(7)
,
Volker Musahl
(8)
,
Siddharth Joglekar
(9)
,
Ajit J Deshmukh
(10)
,
Kevin Plancher
(11)
,
Nikhil Verma
(12)
,
David Mcallister
(13)
,
Peter Verdonk
(14)
,
Sebastien Lustig
(15)
,
Amit Chandrateya
(16)
,
Robert Smigleiski
(17)
,
Gandhi Solayar
(18)
,
Bancha Chernchujit
(19)
,
Patrick Yung
(20)
,
Nicolaas Budhiparama
(21)
,
Yuichi Hoshino
(22)
,
Nathan White
(23)
,
David Parker
(24)
,
Mark Clatworthy
(25)
,
Charlie Brown
(26)
,
Mojieb Manzary
(27)
,
David Rajan
(28)
,
Abhay Narvekar
(29)
,
Sachin Tapasvi
(30)
,
Dinshaw Pardiwala
(31)
,
Ranjit Panigrahi
(32)
,
S. Arumugam
(33)
,
Vikash Kapoor
(34)
,
Bharat Mody
(35)
,
Jitender Maheshwari
(36)
,
Vivek Dahiya
(37)
,
Clement Joseph
(38)
,
Mukesh Laddha
(39)
,
Ashok Rajgopal
(40)
1
Shree Meenakshi Orthopedics and Sports Medicine Clinic
2 McMaster University [Hamilton, Ontario]
3 Sancheti Institute for Orthopaedics and Rehabilitation and PG College
4 Sancheti Institute for Orthopedics and Rehabilitation
5 Hospital for Special Surgery
6 Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery
7 University of Cincinnati College of Medicine
8 UPMC - University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis]
9 Orthopedic Service, VA Central California Health Care System
10 NYU Langone Health
11 Albert Einstein College of Medicine [New York]
12 Rush University Medical Center [Chicago]
13 David Geffen School of Medicine [Los Angeles]
14 UA - University of Antwerp
15 LBMC UMR T9406 - Laboratoire de Biomécanique et Mécanique des Chocs
16 Princess of Wales Hospital Bridgend
17 LIFE Institute Biological Treatment Centre
18 Orthopaedic Specialist Centre
19 TU - Thammasat University
20 CUHK - The Chinese University of Hong Kong [Hong Kong]
21 UNAIR - Universitas Airlangga
22 Kobe University
23 Melbourne Knee Centre
24 Sydney Orthopaedic Research Institute
25 Middlemore Hospital
26 International Knee and Joint Centre
27 JHU - Johns Hopkins University
28 Ortho One-Orthopaedic Speciality Centre
29 Global Hospital Parel
30 The Orthopaedic Speciality Clinic
31 Kokilaben Dhirubhai Ambani Hospital
32 Hitech Medical College and Hospital
33 Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research, Deemed University
34 Medica Hospitals
35 Welcare Hospital
36 Sitaram Bharatiya Hospital
37 Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics
38 Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute
39 RNH Hospital
40 Medanta Medicity
2 McMaster University [Hamilton, Ontario]
3 Sancheti Institute for Orthopaedics and Rehabilitation and PG College
4 Sancheti Institute for Orthopedics and Rehabilitation
5 Hospital for Special Surgery
6 Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery
7 University of Cincinnati College of Medicine
8 UPMC - University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis]
9 Orthopedic Service, VA Central California Health Care System
10 NYU Langone Health
11 Albert Einstein College of Medicine [New York]
12 Rush University Medical Center [Chicago]
13 David Geffen School of Medicine [Los Angeles]
14 UA - University of Antwerp
15 LBMC UMR T9406 - Laboratoire de Biomécanique et Mécanique des Chocs
16 Princess of Wales Hospital Bridgend
17 LIFE Institute Biological Treatment Centre
18 Orthopaedic Specialist Centre
19 TU - Thammasat University
20 CUHK - The Chinese University of Hong Kong [Hong Kong]
21 UNAIR - Universitas Airlangga
22 Kobe University
23 Melbourne Knee Centre
24 Sydney Orthopaedic Research Institute
25 Middlemore Hospital
26 International Knee and Joint Centre
27 JHU - Johns Hopkins University
28 Ortho One-Orthopaedic Speciality Centre
29 Global Hospital Parel
30 The Orthopaedic Speciality Clinic
31 Kokilaben Dhirubhai Ambani Hospital
32 Hitech Medical College and Hospital
33 Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research, Deemed University
34 Medica Hospitals
35 Welcare Hospital
36 Sitaram Bharatiya Hospital
37 Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics
38 Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute
39 RNH Hospital
40 Medanta Medicity
Résumé
PURPOSE: There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic.METHODS: The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus.RESULTS: Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis.CONCLUSION: It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.