Embolic events during major orthopedic surgery

Abstract

Major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR] or hip fracture surgery [HFS]) carries a high risk of venous thromboembolism (VTE), cement and air embolism that may lead to serious complications like pulmonary embolism (PE) following orthopedic surgery. Embolic events is a potentially life-threatening condition, Clinicians must be aware of this silent but dangerous entity that can occur during many seemingly routine operative procedures and interventions. Unfortunately, there remains a paucity of prospective, controlled trials to assess various preventative and treatment options. Emphasis is given to the prevention through many procedures that had been discussed and prompt recognition of this event and to the use of all available tools (fluids, positive ionotropic agents) in the management of cardiovascular complications. Standard management of uncomplicated PE and DVT has been well described in multiple publications. This scientific statement has evaluated the body of literature for management of massive and submassive acute PE and to make recommendations to guide the busy clinician. It shares a significant limitation with other guideline documents in that the body of evidence to guide management for these forms of VTE is incomplete, and therefore, some recommendations must rely on lower levels of evidence or expert opinion. There are several important clinical questions in the management of acute VTE that could be tested . In addition to guiding practice, the authors humbly anticipate that this document will help highlight these gaps and support the case for future clinical trials for these serious forms of VTE and their novel therapies. We strongly advise further clinical trials of the advanced therapies for VTE reviewed here.