Development of DVT in an operated case of cemented bipolar hemiarthroplasty during COVID pandemic: a case report
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20220619Abstract
One of the most common treatment for fracture neck of femur in the elderly is bipolar hemi-arthroplasty which is associated with the patient being mobilized early, lower complication rate, longer implant life. Both uncemented and cemented arthroplasty have been associated with good outcomes, however cemented arthroplasty has higher incidences of DVT due to the thrombogenic potential of cement in addition to the hypercoagulability due to the femoral fracture. Hence, DVT remains a life-threatening complication of arthroplasty, despite the preventive measures owing also to certain genetic and acquired risk factors. We have a 70-year-old female patient, who presented to us with a post traumatic right sided displaced neck of femur with greater trochanter fracture following an alleged history of slip and fall at home who was operated with cemented bipolar hemi-arthroplasty. The patient developed deep vein thrombosis of the operated limb even after adequate mobilization with full weight bearing over the operated limb from post op day 2 and other adequate physiotherapy exercises such as hip/knee ROM exercises and ankle pump exercises. Although, our case report seems to be too far-fetched in terms of correlating this episode of DVT even after adequate mobilization from POD-2 to the ongoing COVID-19 pandemic causing a sub-clinical asymptomatic coronavirus infection causing an increased hypercoagulability of the blood as has been demonstrated by various studies, it does provide substantial evidence which warrants wider multi-centric studies in order to provide a definite correlation of the aforementioned scenario.
References
Maini PS, Talwar N, Nijhawan VK, Manish D. Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck - 10-year study. Indian Journal of Orthopaedics. 2006;40:10.4103/0019-5413.34481.
Francis CW, Marder VJ, Evarts CM. Lower risk of thromboembolic disease after total hip replacement with non-cemented than with cemented prostheses. Lancet. 1986;1:769-71.
Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost. 2010;8:2105-12.
Geerts WH, Pineo GF, Heit JA. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:338S-400S.
White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003;90:446-55.
Dhillon KS, Askander A, Doraismay S. Postoperative deep-vein thrombosis in Asian patients is not a rarity: a prospective study of 88 patients with no prophylaxis. J Bone Joint Surg Br. 1996;78:427-30.
Yoo MC, Kang CS, Kim YH. A prospective randomized study on the use of nadroparin calcium in the prophylaxis of thromboembolism in Korean patients undergoing elective total hip replacement. Int Orthop. 1997;21:399-402.
Dahl OE, Caprini JA, Colwell CW, Jr, Frostick SP, Haas S, Hull RD. Fatal vascular outcomes following major orthopedic surgery. Thromb Haemost. 2005;93(5):860-866.
Rinecker H. New clinico-pathophysiological studies on the bone cement implantation syndrome. Arch Orthop Trauma Surg. 1980;97:263-74.
López JA, Chen J. Pathophysiology of venous thrombosis. Thromb Res. 2009;123:S30-4.
Biswas S, Thakur V, Kaur P, Khan A, Kulshrestha S, Kumar P. Blood clots in COVID-19 patients: Simplifying the curious mystery. Med Hypotheses. 2021;146:110371.