Outcome of calf deep-vein thrombosis after total knee arthroplasty

We investigated the outcome of deep-vein thrombosis (DVT) in the calf after total knee arthroplasty (TKA) in 48 patients (45 women and three men) by clinical assessment and venographic study between three and four years after surgery. The mean age of the patients was 67.2 +/- 7.7 years (52 to 85) and the mean follow-up was 42.6 +/- 2.7 months (38 to 48). The diagnosis was osteoarthritis in 47 patients and rheumatoid arthritis in one patient. There were 44 calf thrombi, four popliteal thrombi but no thrombi in the femoral or iliac regions. Of the 48 patients, 24 were clinically symptomatic and 24 were asymptomatic. Clinical examination was carried out on 41 patients, of whom 37 underwent ascending venography. Seven were evaluated by telephone interview. No patient had the symptoms or signs of recurrent DVT, venous insufficiency in the affected leg, or a history of pulmonary embolism. No patient had been treated for complications of their DVT. Thirty-six of the 37 venographic studies were negative for either old or new DVT in the affected leg. One patient had residual thrombi in the muscular branches of the veins. Our study shows that deep-vein thromboses in the calf after TKA disappear spontaneously with time. No patient developed a recurrent DVT, proximal propagation or embolisation. Treatment of DVT in the calf after TKA should be based on the severity of the symptoms during the immediate postoperative period.