Pulmonary embolism and its prophylaxis following the Charnley total hip replacement

The incidence of pulmonary emboli after a standardized technique of total hip replacement in a series of 7,959 hip arthroplasties operated on between 1962 and 1973 was 1.04% fatal and 7.89% non-fatal. 1,174 had no prophylaxis against embolism with a fatality rate of 2.3% and non-fatal embolism in 15.2%. Phenindione, intravenous heparin and dextran all reduced the complication rate to about 1% fatal and 8% non-fatal but none was statistically better than another. Statistically, plaquenil (hydroxychloroquine sulphate), was as good as any of the other methods used and had few complications. Analysis of the blood groups, pre and post-operative hemoglobin levels, major and revision surgery showed little relationship to the incidence of embolism. The most frequent time of onset of embolism (75%) occurred in the second and third postoperative weeks with only 10% in the first week.