Venous Thromboembolism After Shoulder Arthoplasty and Arthroscopy

Catherine M. Rapp, MD; Edward J. Shields, MD; Brett P. Wiater, MD; J. Michael Wiater, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(8):265-274. 

In This Article

Abstract and Introduction

Abstract

Venous thromboembolism (VTE) in the orthopaedic literature largely focuses on lower extremity trauma and arthroplasty, with relatively few investigations of VTE after shoulder surgery. Because the rate of shoulder surgery, especially arthroplasty, continues to expand, it is important for practicing surgeons to understand the magnitude of risk, potential consequences, and prevention methods with regard to VTE. VTE after shoulder surgery has been a topic of increasing interest over the past decade, and the purpose of this review is to examine the recent literature on pathophysiology, risk factors, incidence, diagnosis, sequelae, prevention, treatment, and current recommendations regarding VTE after shoulder surgery.

Introduction

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), carries a significant clinical and financial burden for patients and the healthcare sector.[1–3] In the United States, the total 1-year costs per patient with VTE can range up to $33,000.[3] Patients who sustain a VTE event carry a risk of life-long sequelae and even death. Postthrombotic syndrome, affecting up to 30% of VTE patients, is detrimental to a patient's quality of life because of chronic hyperpigmentation, edema, pruritus, paresthesias, pain, and ulceration, with a 1-year cost burden up to $11,700.[1–3] Additional long-term sequelae from the disease include recurrence of VTE, PE, chronic thrombotic pulmonary hypertension, and complications related to treatment including adverse or allergic drug reaction, bleeding events, and drug-induced thrombocytopenia.[1,2]

VTE has long been known as a major complication of orthopaedic surgery after lower extremity (LE) total joint arthroplasty and trauma. Although once considered an unlikely event after shoulder arthroscopy, VTE is now a known complication of elective upper extremity (UE) surgery albeit at lower rates than after LE surgery.[4,5] Given the increasing incidence of shoulder arthroscopy and arthroplasty,[6] an understanding of the disease process and incidence is essential when formulating a balanced prevention strategy as well as recognizing, diagnosing, and appropriately treating the disease.

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