The Journal of Bone and Joint Surgery, Vol 76, Issue 11 1658-1663, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
The clinical course of distal deep venous thrombosis after total hip and total knee arthroplasty, as determined with duplex ultrasonography
CS Oishi, JC Grady-Benson, SM Otis, CW Colwell and RH Walker
Division of Orthopaedic Surgery, Scripps Clinic and Research Foundation, La Jolla, California 92037.
Duplex ultrasonography was used to screen 273 consecutive patients, on the
fourth day after a total hip or total knee arthroplasty, for the presence
of a distal deep venous thrombosis. Patients who had a history of
thromboembolic disease or who had an active neoplasm were excluded from the
study. Of the 273 patients, twenty-four (9 per cent) were found to have a
proximal deep venous thrombosis (a thrombosis involving the femoral or
popliteal veins) and forty-one (15 per cent), a distal deep venous
thrombosis (a thrombosis involving the veins of the calf). All of the
thromboses were asymptomatic. The forty-one patients in whom a distal deep
venous thrombosis had been detected with duplex screening subsequently had
serial duplex examinations, on the seventh and fourteenth postoperative
days. If a proximal deep venous thrombosis was detected, anticoagulation
was begun immediately. If no proximal thrombosis was observed, the distal
thrombosis was considered stable, the serial duplex examinations were
terminated, and clinical observation was continued. Of the forty-one
patients who had serial examinations, seven (17 per cent) had a proximal
deep venous thrombosis in the ipsilateral limb by the fourteenth
postoperative day; all seven were asymptomatic, and all were managed with
anticoagulation. Thirty-four patients (83 per cent) were determined to have
a stable distal deep venous thrombosis on the fourteenth postoperative day,
and no additional duplex examinations were performed. Thirty-three (97 per
cent) of these thirty-four patients remained asymptomatic for deep venous
thrombosis thereafter; the remaining patient (3 per cent) had a proximal
deep venous thrombosis in the ipsilateral limb eleven months
postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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