Does systematic duplex ultrasonography detect asymptomatic venous thrombosis and prevent pulmonary embolism in patients following total hip arthroplasty?
Systematic duplex ultrasonography performed twice during hospitalization after total hip arthroplasty detected venous thrombosis in 12% of patients (mostly asymptomatic), potentially explaining the absence of pulmonary embolism.
This study evaluates a pragmatic approach using duplex ultrasonography (US) for detecting venous thromhosis (VT) after total hip arthroplasty (THA). Venous B-mode and colour duplex US examination of both legs including a systematic evaluation of calf veins was performed twice during hospitalisation in 286 consecutive patients. VT was diagnosed in 31 patients (12%). Thrombosis was asymptomatic in 28 patients (90%), and was bilateral or concerned the non-operated leg in 6 patients (19,4%). No clinical pulmonary embolism occurred during hospitalisation. Prior phlebitis and age over 70 were identified as statistically significant risk-factors (p<0,02 and p<0.04 respectively). All patients were seen at three months. Four patients (1.6%) developed VT between hospital discharge and the 3-month follow-up visit. Venous US performed twice after THA detected VT in 31 patients, 90% of these were asymptomatic. This approach might explain the absence of pulmonary embolism (PE) in our series, and support a systematic evaluation of the vein of the lower limb with ultrasonography after THA.
Thomasson et al. (1999) studied this question.