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The Journal of Bone and Joint Surgery 78:111-3 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Fatal Pulmonary Embolism during Manipulation after Total Knee Arthroplasty. A Case Report*

MICHAEL S. STECKER, M.D.{dagger} and MICHAEL D. RIES, M.D.{dagger}, COOPERSTOWN, NEW YORK

Investigation performed at The Mary Imogene Bassett Hospital, Cooperstown


   Introduction
 
Deep venous thrombosis occurs in approximately 40 to 60 per cent of patients who have a total knee arthroplasty5,10,11,13,15,17,18. However, symptomatic pulmonary embolism occurs in only 1 to 2 per cent9,10,17-19, and fatal pulmonary embolism has been reported in 0.2 per cent of patients who received no anticoagulation therapy8.

The relatively high frequency of deep venous thrombosis and low prevalence of pulmonary embolism may be related to the location of the thrombus. Most deep venous thrombi occur in the calf10,13,18, and they do not appear to be associated with as serious a risk of pulmonary embolism as more proximal thrombi. The role of routine anticoagulation therapy for treatment of the relatively common thrombosis of the calf and for prevention of the relatively uncommon fatal pulmonary embolism has recently been questioned8.

Complications of manipulation after total knee arthroplasty include rupture of the patellar ligament, fracture of . . . [Full Text of this Article]


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J. Parvizi, T. A. Sullivan, R. T. Trousdale, and D. G. Lewallen
Thirty-Day Mortality After Total Knee Arthroplasty
J. Bone Joint Surg. Am., August 1, 2001; 83(8): 1157 - 1161.
[Abstract] [Full Text]