The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA Rationale and Clinical Results of a Multimodal Prophylaxis ProtocolSalvati, Eduardo A, MD*; Sharrock, Nigel E, MB, ChB†; Westrich, Geoffrey, MD*; Potter, Hollis G, MD‡; Valle, Alejandro González Della, MD*; Sculco, Thomas P, MD
Total hip arthroplasty is an operation with a high risk for venous thromboembolism. Three decades of research conducted at the Hospital for Special Surgery identified the exact timing of the thrombogenic stimulus during surgery, defined the role of magnetic resonance venography, and established the role of certain genetic and acquired predispositions. Based on these studies, we implemented a multimodal prophylaxis consisting of a series of safe preventive measures applied before, during, and immediately after surgery to reduce the risk of venous thromboembolism. If these safe preventive measures are strictly observed, postoperative pharmacologic prophylaxis does not need to be aggressive in the patient without predisposing factors who mobilizes promptly, thus diminishing the risk of bleeding associated with the use of anticoagulants and the overall cost of care. Our clinical experience with more than 5000 total hip arthroplasties performed during the last decade and closely followed prospectively for a minimum of 3 months clearly shows this multimodal prophylaxis is safe and effective resulting in a very low prevalence of thromboembolism.