Our Summary

This research paper is a study on the occurrence of blood clots (venous thromboembolism or VTE) after total shoulder replacement (TSR) or total elbow replacement (TER) surgeries. The researchers found a wide range of reported clotting incidents after these surgeries, which made them unsure about the exact risks involved. They wanted to understand the factors that could increase the chances of getting a clot after either surgery.

To do this, they reviewed several studies (43 articles, to be exact) on the subject that had been conducted up until September 2019. These studies included data on over 672,000 shoulder and elbow replacement surgeries.

They found that less than 1% of patients developed blood clots within three months of having TSR or TER surgeries. However, certain factors seemed to increase the risk of getting a clot after a TSR. These included being older, being overweight (having a body mass index of 25 or more), and abusing alcohol.

Additionally, patients with certain health conditions (like chronic lung disease, previous blood clots, heart failure, anemia, blood clotting disorders, irregular heartbeat, epilepsy, urinary tract infections, sleep apnea, and fluid & electrolyte imbalance) were also more likely to develop clots after a TSR. Interestingly, having the surgery done on an outpatient basis or on a specific part of the shoulder seemed to reduce the clotting risk.

In conclusion, the researchers suggest that high-risk patients (like the elderly, those with previous clotting history, and those having reverse or inpatient TSR) should be closely monitored. They also suggest identifying and addressing factors like high body weight, alcohol abuse, and pre-existing health conditions before the surgery to reduce the risk of post-surgery clotting.

FAQs

  1. What is the incidence of venous thromboembolism (VTE) following total shoulder replacement (TSR) or total elbow replacement (TER)?
  2. What factors increase the risk of VTE following TSR or TER?
  3. What methods can be used to minimize the risk of VTE following TSR or TER?

Doctor’s Tip

One helpful tip a doctor might tell a patient about shoulder replacement is to be aware of the risk factors for venous thromboembolism (VTE) following the procedure. These risk factors may include older age, high BMI, alcohol abuse, chronic pulmonary disease, previous VTE history, and certain comorbidities such as heart failure and arrhythmia. Patients in high-risk groups may need closer monitoring and should address modifiable risk factors before surgery. It is important to follow your doctor’s recommendations for post-operative care and rehabilitation to reduce the risk of complications like VTE.

Suitable For

Patients who are typically recommended for shoulder replacement surgery include those with severe shoulder arthritis, irreparable rotator cuff tears, severe fractures of the shoulder joint, or other conditions that cause significant pain and limited function in the shoulder. Other factors that may influence the recommendation for shoulder replacement surgery include the patient’s age, overall health, and ability to tolerate the surgery and rehabilitation process.

Timeline

Before shoulder replacement:

  • Patient experiences chronic shoulder pain, stiffness, and limited range of motion
  • Consults with orthopedic surgeon for evaluation and discussion of treatment options
  • Pre-operative assessments and tests are conducted to ensure patient is a suitable candidate for surgery
  • Patient receives education on the procedure, potential risks, and expected recovery process

After shoulder replacement:

  • Patient undergoes surgery to replace the damaged shoulder joint with an artificial implant
  • Post-operative pain management and physical therapy are initiated to aid in recovery and rehabilitation
  • Patient is monitored for complications such as infection, nerve damage, or blood clots
  • Gradual improvement in shoulder function and pain relief is observed over time
  • Long-term follow-up appointments are scheduled to monitor the success of the surgery and address any ongoing issues or concerns.

What to Ask Your Doctor

  1. What is the average incidence of venous thromboembolism (VTE) following shoulder replacement surgery?
  2. Are there any specific risk factors that may increase my risk of developing VTE following shoulder replacement surgery?
  3. What steps can be taken to monitor and prevent VTE after shoulder replacement surgery?
  4. How will my age, body mass index (BMI), and other comorbidities impact my risk of developing VTE?
  5. Are there any lifestyle changes or modifications that can help reduce the risk of VTE before and after surgery?
  6. What are the signs and symptoms of VTE that I should be aware of after surgery?
  7. How often will I need to follow up with you or another healthcare provider to monitor for VTE post-surgery?
  8. Will I be prescribed any medications or interventions to prevent VTE after shoulder replacement surgery?
  9. Are there any specific activities or behaviors I should avoid to reduce my risk of developing VTE?
  10. What should I do if I suspect I may have developed a VTE after shoulder replacement surgery?

Reference

Authors: Kunutsor SK, Barrett MC, Whitehouse MR, Blom AW. Journal: Thromb Res. 2020 May;189:13-23. doi: 10.1016/j.thromres.2020.02.018. Epub 2020 Feb 20. PMID: 32135385