Blood clots after hip or knee replacement have historically been regarded as commonly occurring.  We have progressively worked on the factors involved; we avoid tying the patient to the bed with tubes, we require early mobilisation after surgery, we use Venosan Silverline compression stockings rather than the old TED’s. The advantage of these black stockings is increased calf compression (20-30mmHg) up from the traditional 10mmHg.  As a result we have been able to change from using injections for blood thinning to just aspirin, which also has additional advantages of reducing the risk of heart attack and stroke after surgery.

An audit of the last 138 patients having ultrasounds after hip or knee replacement suggests our rate to be 5.5% with hip replacement and 10.4% with knee replacement. Obviously greater numbers are needed to be sure, but these rates are substantially below O’Reilly’s study from Sydney published in 2005 with a rate of 8.9% for hip replacement and 25.6% for knee replacement despite using warfarin or low molecular weight heparin.  Small clots below the knee are treated with aspirin and compression stockings- ie no change to the treatment plan.

We believe that early mobilisation and early discharge to home to be key to avoiding complications. We do stratify the individual risks, patients with previous clots need to be treated more aggressively.