Deep vein thrombosis in shoulder arthroplasty – a prospective study

Thayur R Madhusudhan, Amit Sinha, David Widdowson

BACKGROUND: Shoulder arthritis of varied aetiology is often disabling and patients seek treatment for pain relief and restricted movements. Though non operative measures in the form of analgesics, physiotherapy and joint injections offer satisfactory results in the early stages; operative treatment in the form of joint replacements becomes necessary in late and advanced stages. The above operations are being performed more frequently in the recent years across the National Health Service [NHS] in the UK with increasing success in specialised units and the outcome of the operation is often rewarding. In addition to the other complications, risks of Deep vein thrombosis [DVT] and pulmonary embolism [PE] exists. Available evidence suggests a low incidence but the true risk has only been partially addressed. The final decision to consider thromboprophylaxis rests with the operating surgeon. It is important to carefully balance the clinical decision of thromboprophylaxis and bleeding with wound complications, which add considerable morbidity and mortality. To define the risk of DVT in this subgroup of patients is the initial step to enable better use of resources and achieve cost effectiveness. This we believe will provide robust evidence to help formulate guidelines for thromboprophylaxis in shoulder arthroplasty.Methods/design: The aim will be to determine whether shoulder arthroplasties carry a risk of DVT. A cohort of 100 consecutive patients being considered for shoulder arthroplasty for degenerative arthritis, rotator cuff arthropathy, inflammatory arthropathy including rheumatoid arthritis will be prospectively considered for the study. All eligible patients will be assessed clinically and screened for DVT in all 4 limbs both pre and postoperative with Doppler scans within a 6 week perioperative period. We aim to include the reasons for non inclusion of eligible patients and patient's perspective of their general well being in relation to DVT. DISCUSSION: We present the risk of DVT associated with shoulder arthroplasties to establish a good quality evidence for thromboprophylaxis. The study is underway and we would further be able to define whether the general risk factors for DVT are relevant to shoulder replacements.