Pulmonary emboli followed total hip arthroplasty: incidence study

Area of Science:

• Orthopedic Surgery
• Cardiopulmonary Medicine
• Diagnostic Imaging

Background:

• Pulmonary embolism (PE) is a potential complication following lower extremity surgery.
• Clinical signs of PE are not always apparent, necessitating objective diagnostic methods.
• Preoperative findings can complicate the interpretation of postoperative diagnostic tests.

Purpose of the Study:

• To investigate the incidence of pulmonary embolism in patients undergoing total hip arthroplasty compared to other lower extremity surgeries.
• To evaluate the utility of preoperative and postoperative lung scans and pulmonary angiography in diagnosing PE.
• To assess the role of blood gases and serum enzymes in PE detection.

Main Methods:

• Comparison of 25 total hip arthroplasty patients with 25 patients undergoing other lower extremity operations.
• Preoperative and postoperative assessment using lung perfusion scans, ventilation scans, and pulmonary angiography.
• Analysis of blood gas levels and serum enzyme concentrations.

Main Results:

• An overall incidence of 6% for pulmonary embolism was observed.
• Clinical evidence of PE was absent in the diagnosed cases.
• Preoperative scan and blood study abnormalities were common, making postoperative changes crucial for diagnosis.

Conclusions:

• Pulmonary embolism can occur postoperatively in lower extremity surgery patients without overt clinical signs.
• Diagnostic imaging and laboratory tests, particularly changes from preoperative baselines, are essential for accurate PE diagnosis.
• Routine screening for PE may be warranted in select patient populations undergoing lower extremity procedures.