Why there can be pulmonary thromboembolism after total knee replacement or total hip replacement?

Why there can be pulmonary thromboembolism after total knee replacement or total hip replacement?

Pulmonary thromboembolism, also known as a pulmonary embolism (PE), is a potentially serious condition where a blood clot (thrombus) forms in one part of the body (often in the legs) and then travels through the bloodstream, eventually lodging in the pulmonary arteries, which supply blood to the lungs. Total knee replacement (TKR) and total hip replacement (THR) are surgical procedures commonly performed to replace damaged or arthritic joints with artificial implants. Patients undergoing these surgeries are at an increased risk of developing pulmonary thromboembolism for several reasons:

  1. Immobilization: After TKR or THR, patients are often immobile or have limited mobility during the initial recovery period. Immobility can lead to sluggish blood flow in the legs, which increases the risk of blood clot formation.
  2. Injury to blood vessels: During the surgical procedure, there is a potential for injury to blood vessels, which can initiate clot formation.
  3. Activation of clotting factors: Surgery itself can trigger a release of pro-coagulant substances, leading to a hypercoagulable state, where the blood is more prone to clotting.
  4. Stasis during surgery: While undergoing surgery, patients may be in a position that reduces blood flow to the lower extremities, increasing the risk of clot formation.
  5. Reaction to implants: The presence of artificial joint implants can lead to local inflammation and blood flow disturbances, which may contribute to clot formation.
  6. Prolonged hospitalization: Following the surgery, patients are often hospitalized for a few days, and prolonged hospital stays are associated with an increased risk of developing blood clots.

To reduce the risk of pulmonary thromboembolism after TKR or THR, various preventive measures are typically implemented. These may include:

  • Early mobilization: Encouraging patients to move and exercise as soon as possible after surgery to promote blood flow.
  • Compression stockings: Wearing compression stockings to improve blood circulation in the legs.
  • Anticoagulant medication: Prescribing blood-thinning medications (anticoagulants) like heparin or low-molecular-weight heparin to prevent clot formation.
  • Intermittent pneumatic compression: Using special devices that periodically compress the legs to enhance blood flow.
  • Early ambulation and physical therapy: Engaging in physical therapy and walking exercises to improve mobility and blood circulation.

It’s important for patients undergoing TKR or THR to be aware of the risk of pulmonary thromboembolism and follow their healthcare provider’s recommendations for preventing this potentially serious complication. Always discuss any concerns or questions about the surgery and postoperative care with your healthcare team.