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Hematologic Genetic Testing in High-risk Patients Before Knee Arthroplasty: A Pilot Study

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patients with a personal or familial history of thromboembolism are considered at higher risk for thromboembolic disease after knee arthroplasty. While it remains unclear why some patients develop deep vein thrombosis (DVT) or pulmonary embolism (PE) despite similar operative procedures and the same prophylactic regimen, we presume one explanation would be genetic predisposition.

Questions/purposes

We determined the frequency of 12 factors including antithrombin III activity, prothrombin gene mutations, and the presence of phospholipid antibodies in a high-risk patient cohort and compared those findings with the known prevalence in the population at large.

Patients and Methods

Patients identified preoperatively as having a personal or familial history of DVT and/or PE were referred for hemostatic serum and genetic tests, including % antithrombin III activity (ATIII), protein C and protein S activities, APC resistance, Factor V gene (Leiden) mutations, prothrombin gene mutations, lupus anticoagulant antibody presence, cardiolipin antibody presence, phosphatidyl antibody presence, β2-glycoprotein antibody presence, and serum homocysteine and lipoprotein(a) levels The frequencies of varying abnormalities were identified and compared to the prevalence reported in the literature.

Results

Forty-three of 1944 patients undergoing knee arthroplasty had a history of DVT or PE. Sixteen of 43 (37%) patients had an abnormality and eight of these (19%) had two or more abnormalities. The frequency of nine of the 12 tests appeared to be greater in this cohort than in the population at large.

Conclusions

Patients with a personal or familial history of DVT or PE appear to have a high frequency of hereditary prothrombotic abnormalities. Preoperative evaluation by a hematologist may be warranted in patients with a personal or familial history of DVT or PE as the postoperative anticoagulation protocols may be altered and identification of these abnormalities may affect a patient’s risk for other disease states.

Level of Evidence

Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA

    Hany Bedair MD

  2. Massachusetts General Hospital, Boston, MA, USA

    Hany Bedair MD

  3. Center for Joint Reconstruction, 2014 Washington Street, Newton, MA, 02462, USA

    Hany Bedair MD

  4. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Martin Berli MD, Joshua J. Jacobs MD & Craig J. Della Valle MD

  5. Department of Hematology, Rush University Medical Center, Chicago, IL, USA

    Sefer Gezer MD

Authors
  1. Hany Bedair MD
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  2. Martin Berli MD
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  3. Sefer Gezer MD
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  4. Joshua J. Jacobs MD
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  5. Craig J. Della Valle MD
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Corresponding author

Correspondence to Hany Bedair MD.

Additional information

Dr. Jacobs is a consultant for Medtronic Sofamor Danek (Minneapolis, MN) and Zimmer Inc (Warsaw, IN) and receives research/institutional support from Advanced Spine Technologies Inc (San Francisco, CA), Medtronic Sofamor Danek, SpinalMotion Inc (Mountain View, CA), Wright Medical Technologies Inc (Arlington, TN), and Zimmer Inc. Dr. Della Valle is a consultant for Angiotech (Vancouver, BC, Canada), Kinamed (Camarillo, CA), Smith and Nephew Inc (Memphis, TN), and Biomet Inc (Warsaw, IN) and receives research/institutional support from Zimmer Inc.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Rush University Medical Center.

Appendix

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Bedair, H., Berli, M., Gezer, S. et al. Hematologic Genetic Testing in High-risk Patients Before Knee Arthroplasty: A Pilot Study. Clin Orthop Relat Res 469, 131–137 (2011). https://doi.org/10.1007/s11999-010-1514-2

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  • DOI: https://doi.org/10.1007/s11999-010-1514-2

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