Preventing Cast Problems After Surgery

Last updated: 08-04-2020

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Preventing Cast Problems After Surgery

People who undergo arthroscopic knee surgery often need to have their leg placed in a cast to help keep it immobilized while they recover. However, new research suggests that individuals who have their leg casted after knee surgery are at an increased risk for deep venous thromboembolisms or pulmonary embolisms. Blood clots like these can cause significant problems and in rare cases can lead to death.

To combat this, foot and ankle specialists have been told to prescribe their knee surgery patients with prophylaxis, or anti-blood coagulant medication. This would seem to work in theory, but a new study suggests that there isn’t a lot of hard evidence that suggests prophylaxis are effective at preventing complications after arthroscopic knee surgery. This is especially problematic when you consider that arthroscopic knee surgery is the most commonly performed orthopedic procedure in the world, with more than four million patients undergoing the procedure every year.
Preventing Complications After Casting

Cast immobilization is a common practice for foot and ankle orthopedic surgeons after surgery, and there is often outside pressure on the doctor to prescribe the patient with an anti-coagulant. Anti-coagulants should help to prevent blood clots from forming in casted patients after arthroscopic knee surgery, but this also increases a person’s risk for bleeding issues, since the blood can’t clot as easily. Essentially, anti-coagulants are a double-edged sword in that they decrease the risk for one complication while increasing the risk for another potential problem. Excessive bleeding can make a minor wound issue a major problem in a hurry.

In my practice, I make it a point to consider every patient individually to make the best decisions based on the patient’s risk factors. This includes looking at their medical and family history, knowing if they are on any medications, analyzing their age and their surgery, predicting potential complications and much more to ensure the patient has the best chance of a speedy and straightforward recovery.

This method has been shown in recent literature to be the best method to decrease complications like deep venous thromboembolism or pulmonary embolisms without unnecessarily raising the bleeding complication risks. I’m glad to see that the methods we practice at Silverman Ankle & Foot are being shown to be the industry’s best practices, and I hope it becomes the norm in the foot and ankle community, as patients shouldn’t just be given an anti-coagulant after surgery and sent on their way. In order to best protect and help our patients heal, we need to consider each case individually and adapt to each patient’s specific needs.

If you have questions about a surgical operation or a foot and ankle issue, send your question to Dr. Silverman in the box below.


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