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Duplex ultrasonography after total hip or knee arthroplasty
1Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, S.A.R. peterko@graduate.hku.hk
Insights
Isolated distal deep vein thrombosis (DVT) is common but asymptomatic in low-risk Chinese patients after hip or knee replacement. Monitoring with duplex ultrasonography may be considered if anticoagulation is not used.
Area of Science:
- Orthopedic Surgery
- Vascular Medicine
- Diagnostic Imaging
Background:
- Deep vein thrombosis (DVT) is a potential complication following major orthopedic surgery.
- Routine pharmacologic anticoagulation is not universally applied in all patient populations undergoing arthroplasty.
Purpose of the Study:
- To investigate the incidence and clinical significance of DVT in Chinese patients undergoing total hip (THR) or knee (TKR) arthroplasty without pharmacological anticoagulation.
- To evaluate the utility of duplex ultrasonography for monitoring DVT in this cohort.
Main Methods:
- Prospective study of 80 patients (22 THR, 58 TKR) aged 68 years, excluding high-risk DVT individuals.
- Postoperative duplex ultrasonography on postoperative days 5-7 to detect DVT.
- Follow-up scans on days 10-14 for distal DVT cases to assess propagation.
Main Results:
- Distal DVT was detected in 1/22 THR patients and 9/58 TKR patients.
- All identified DVTs were asymptomatic.
- No proximal propagation of distal DVTs was observed on follow-up scans.
- No postthrombotic symptoms were reported during an 18-month follow-up.
Conclusions:
- Isolated distal DVT is a frequent, yet clinically silent, finding in low-risk Chinese patients post-THR or TKR.
- Duplex ultrasonography monitoring may be a valuable alternative to routine anticoagulation in selected populations.
- Asymptomatic distal DVTs in this cohort did not appear to lead to adverse long-term outcomes.
Abstract:
We prospectively studied all patients admitted for total hip (THR) or knee (TKR) arthroplasty from July 2000 to February 2001. No pharmacological anticoagulation was given. All patients received a standardized postoperative rehabilitation regimen. Forty-six patients with known risk factors for deep vein thrombosis (DVT) were excluded. Eighty patients were studied (22 THR, 58 TKR; 55 women, 25 men). Mean age was 68 (30-90) years. Duplex ultrasonography on both lower limbs was performed on days 5-7 postoperatively. Location and extent of any thrombus were documented. In patients with distal DVT, a follow-up scan was done on days 10-14. If proximal propagation was observed, patients received full anticoagulation. If no propagation was detected, the distal thrombus was considered stable and clinical observation was continued. In the THR group, 1/22 and in the TKR group 9/58 were found to have distal DVT. All were asymptomatic. On follow-up scanning, none showed proximal propagation. All patients were followed up for at least 18 months, and none showed postthrombotic symptoms. Isolated distal DVT in "low-risk" Chinese patients after THR or TKR is not uncommon. Clinically they are usually "silent." If routine perioperative pharmacologic antithrombotic prophylaxis is not practiced, monitoring with duplex ultrasonography may need to be considered.
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