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Thrombembolische Komplikationen nach Sprunggelenkprothesenimplantation

Thromboembolic complications following ankle prosthesis implantation

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Zusammenfassung

Einleitung

Der endoprothetische Ersatz des oberen Sprunggelenks (OSG) wird zunehmend als therapeutische Option bei Patienten mit fortgeschrittenen degenerativen Veränderungen des OSG angewendet. Es gibt jedoch wenige Angaben in der aktuellen Literatur über die Inzidenz der thrombembolischen Komplikationen. Aus diesem Grund haben wir eine Literaturreview mit folgenden Fragestellungen durchgeführt: Thrombembolieprophylaxe und Inzidenz der postoperativen Thrombose/Embolie nach endoprothetischem Ersatz des OSG. Außerdem haben wir die Inzidenz thrombembolischer Komplikationen in unserem Patientenkollektiv evaluiert.

Methoden

Die systematische Literaturreview wurde unter Verwendung von gängigen Datenbanken der medizinischen Literatur durchgeführt. Folgende Angaben wurden berücksichtigt: Methode und Dauer der Thrombembolieprophylaxe und Dokumentation einer Thrombose/Embolie als postoperative Komplikation. Die Inzidenz thrombembolischer Komplikationen wurde in unserem Patientenkollektiv mit 964 Prothesen des OSG evaluiert.

Ergebnisse

Insgesamt wurden 21 klinische Studien für die systemische Literaturreview eingeschlossen. Die Inzidenz thrombembolischer Komplikationen lag zwischen 0,0 und 4,8%. Die Inzidenz der symptomatischen tiefen Beinvenenthrombose betrug in unserem Patientenkollektiv 3,4 %. Es wurden keine Lungenembolien diagnostiziert. Alle Patienten erhielten niedermolekulares Heparin (Dalteparin) als Thrombembolieprophylaxe.

Schlussfolgerung

Die Inzidenz der thrombembolischen Komplikationen in unserem Patientenkollektiv war vergleichbar mit der Inzidenz von Patienten mit endoprothetischem Ersatz des Knie- oder Hüftgelenks oder einer Arthrodese des OSG. Wir empfehlen die Thrombembolieprophylaxe mit einem niedermolekularen Heparin nach endoprothetischem Ersatz des OSG.

Abstract

Background

Total ankle replacement is becoming an increasingly used treatment for patients with degenerative arthritis of the ankle; however, there is limited literature available addressing the incidence of thromboembolic complications after total ankle replacement. Therefore, we performed a systematic literature review addressing thrombosis prophylaxis and incidence of thromboembolic complications after total ankle replacement. Furthermore, we evaluated the incidence of thromboembolic complications in our clinic.

Methods

A systemic literature review was performed using established medical literature data bases. The following information was retrieved from the literature: thrombosis prophylaxis and duration and deep vein thrombosis/pulmonary embolism as postoperative complication. The incidence of thromboembolic complications was evaluated in our patient cohort including 964 total ankle replacement procedures.

Results

A total of 21 clinical studies were included in the systematic literature review. The range of incidence of thromboembolic complications was between 0.0 % and 4.8 %. In our patient cohort the incidence of symptomatic deep vein thrombosis was 3.4 %. There were no cases of pulmonary embolism. All patients received low molecular weight heparin prophylaxis.

Conclusion

The incidence of thromboembolic complications in our patient cohort was comparable to that of symptomatic deep vein thrombosis in patients undergoing total knee or hip replacement or ankle fusion. We suggest the prophylactic use of low molecular weight heparin for patients after total ankle replacement.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Barg, S.W. Schneider, G. Pagenstert, V. Valderrabano geben an, dass kein Interessenkonflikt besteht; B. Hintermann weist auf folgende Beziehung hin: er ist im Speakers Bureau von Integra Lifesciences. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to Dr. A. Barg.

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Barg, A., Schneider, S., Pagenstert, G. et al. Thrombembolische Komplikationen nach Sprunggelenkprothesenimplantation. Orthopäde 42, 948–956 (2013). https://doi.org/10.1007/s00132-013-2173-2

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Schlüsselwörter

  • Oberes Sprunggelenk
  • Sprunggelenkprothese
  • Thrombose/Lungenembolie
  • Thrombembolieprophylaxe
  • Risikofaktoren für Thrombose/Embolie

Keywords

  • Tibiotalar joint
  • Total ankle replacement
  • Thrombosis/pulmonary embolism
  • Thromboembolism, prophylaxis
  • Risk factors for thromboembolic events