Document Detail


Arthrofibrosis following total knee replacement; does therapeutic warfarin make a difference?
MedLine Citation:
PMID:  15749444     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Arthrofibrosis following total knee replacement (TKR) is a relatively common complication which results in a reduction in knee range of movement and patient dissatisfaction. A retrospective study examined the relationship between anticoagulation with therapeutic warfarin and rates of arthrofibrosis following TKR. Arthrofibrosis was defined as less than 80 degrees of knee flexion 6-8 weeks post-TKR. Patients were warfarinised if they had a history of thrombophilic tendencies or medical conditions necessitating anti-coagulation, rather than as routine thromboprophylaxis. All other patients received thromboprophylaxis using low molecular weight heparin. A total of 728 patients underwent 874 primary TKR between 1993 and 2002 in one centre, performed by four surgeons. Mean age was 68 years (range 48-89 years) and there were 483 female and 391 male knees. Eighty cases were warfarinised post-operatively (53 female, 27 male). Overall, 83 of 874 TKRs (9%) had arthrofibrosis (57 female, 26 male) requiring manipulation under anaesthetic (MUA). In the warfarinised group, 21 knees (26%) had an MUA (15 female, 6 male). This compared to 62 cases (8%) requiring MUA in the non-warfarinised group (42 female, 20 male). There was a statistically significant difference on Fisher's exact testing (P<0.0001) between groups. Following MUA, knee flexion improved in 95% cases to a minimum 95 degrees but 8 cases had a fixed flexion deformity of 5-10 degrees . In conclusion, therapeutic warfarinisation post-TKR leads to a statistically greater chance of the patient developing arthrofibrosis compared to prophylactic low molecular weight heparin and that patients should be counseled appropriately.
Authors:
N P Walton; I Jahromi; P J Dobson; K R Angel; P L Lewis; D G Campbell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Knee     Volume:  12     ISSN:  0968-0160     ISO Abbreviation:  Knee     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-03-07     Completed Date:  2005-06-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9430798     Medline TA:  Knee     Country:  England    
Other Details:
Languages:  eng     Pagination:  103-6     Citation Subset:  IM    
Affiliation:
Wakefield Orthopaedic Clinic, 270 Wakefield St., Adelaide, SA 5000, Australia. neil@nwalton22.fsnet.co.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anticoagulants / therapeutic use*
Arthroplasty, Replacement, Knee / adverse effects*
Cohort Studies
Female
Fibrosis / etiology,  pathology,  prevention & control
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Joint Diseases / etiology*,  pathology,  prevention & control
Knee Joint / pathology,  physiopathology,  surgery*
Male
Middle Aged
Musculoskeletal Manipulations
Pliability
Postoperative Complications / pathology,  prevention & control*
Retrospective Studies
Warfarin / therapeutic use*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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