CT pulmonary angiography and pulmonary embolism following 5809 primary joint arthroplasties

Controversy surrounds prevention, detection and clinical relevance of pulmonary embolism (PE) following arthroplasty in orthopaedic patients. We aimed to review the rates of computer tomography pulmonary angiography (CTPA), PE and fatal PE following total joint replacement.

Mixed retrospective/prospective review of CTPA requests and PE incidence amongst patients undergoing primary knee and hip arthroplasty.

The overall PE rate was 112/5809 (1.93%): 38/3473 (1.1%) and 74/2336 (3.5%) following total hip arthroplasty (THA) and total knee arthroplasty (TKA), respectively. Two deaths from PE occurred, both after TKA, a procedural mortality rate of 0.086%; the overall mortality rate was 0.034%. The rate of CTPA requests increased for the initial 7 years as did the rate of PE, in the last 2 years both rates fell.

The findings are discussed in context of published data and with reference to studies suggesting the high sensitivity of CTPA may over diagnose clinically significant PE following arthroplasty if ordered without a robust method of determining the pre-test probability.