The use of routine chemoprophylaxis for deep vein thrombosis in all patients undergoing hip and knee replacements in rural population - whether it is justified?

Background: Deep vein thrombosis (DVT)/ pulmonary embolism (PE) are one of the most feared complications in patients undergoing joint replacements in western literatures. The exact incidence of DVT in Indians particularly rural population remains debatable. Also ways to prevent it in rural population is a dilemma for the orthopedic community. Hence this study was undertaken.Methods: We carried a prospective study of 135 cases of joint replacements i.e. 78 of total hip replacements and 57 of total knee replacements. None of the patients were given any form of chemoprophylaxis like low molecular weight heparin (LMWH). Strict monitoring was done. All patients underwent duplex ultrasonographic doppler assessment of both the lower limbs between the 4th-7th day and on 14th - 16th postoperative day. Only 5 out of 135 cases had DVT. Results: We observed that DVT developed more commonly following total hip replacement surgery (4 cases) as compared to total knee replacement (1 case). There was no mortality in our study.Conclusions: DVT following total joint replacements in rural Indian patients is not as common as reported in the Western literature. A high level of suspicion and close clinical monitoring is mandatory. The use of routine chemoprophylaxis in every patient is perhaps not justified. In future further more trials with a larger number of patients and at multiple centers would be required to confirm the findings of our study and to formulate guidelines to prevent DVT