When Guidelines Permit More Than One Answer: VTE Prophylaxis and the Standard of Care After Arthroplasty

Mortazavi, Seyed Mohammad Javad; Jabalameli, Mahmoud

doi:10.22038/abjs.2026.98862.4411

When Guidelines Permit More Than One Answer: VTE Prophylaxis and the Standard of Care After Arthroplasty

Articles in Press

Document Type : SHORT COMMUNICATION

Authors

Seyed Mohammad Javad Mortazavi ¹

Mahmoud Jabalameli ²

¹ Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

² Department of Orthopedic Surgery, Shafa Yahyaeian Hospita, Iran university of Medical Sciences, Tehran, Iran

10.22038/abjs.2026.98862.4411

Abstract

Venous thromboembolism (VTE) after total joint arthroplasty may occur despite appropriate prophylaxis. However, recommendations regarding agent selection, intensity, and duration vary among professional guidelines and frequently rely on low-certainty evidence. When pulmonary embolism occurs, knowledge of the outcome may make an alternative strategy appear retrospectively obligatory. We argue that adverse outcomes should not transform one evidence-supported approach into substandard care merely because another reasonable approach might have prevented the event. Peer and medicolegal review should assess whether management fell within the range of reasonable, evidence-supported practice based on information available when decisions were made.

Keywords

Venous Thromboembolism

Pulmonary Embolism

Arthroplasty, Replacement, Knee

Practice Guidelines as Topic

Malpractice

Subjects