Table of Contents
Volume 2012, Article ID 837896, 8 pages
Review Article

Thromboembolic Prophylaxis in Total Joint Arthroplasty

1Department of Orthopaedic Surgery, Providence Hospital and Medical Centers, 22250 Providence Drive, Suite No. 401, Southfield, MI 48075, USA
2Detroit Medical Center/Providence Hospital Orthopaedic Residency Program, Warren, MI 48092, USA

Received 30 March 2012; Revised 19 August 2012; Accepted 21 August 2012

Academic Editor: Edith Nutescu

Copyright © 2012 David Knesek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Approximately 775,000 hip and knee arthroplasties are performed yearly in the United States, with a dramatic increase expected. Patients having hip and knee arthroplasties are at high risk of developing a venous thromboembolism. The American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS) have updated guidelines, which outline new prophylactic strategies. Factor Xa inhibitor rivaroxaban has a new recommendation by ACCP and is gradually being adopted by the joint arthroplasty community as an effective oral agent. Other more well-known agents including warfarin, low-molecular-weight heparin, aspirin, and fondaparinux continue to be options for prophylaxis. While the goal of prophylaxis continues to be the prevention of venous thromboemboli and pulmonary emboli, it is important to consider the increased bleeding risk associated with their use. The most recent ACCP and AAOS guidelines give clinicians a greater autonomy in choosing a prophylactic agent with greater emphasis placed on dialogue between the surgeon and patient as to the choice of prophylaxis.