Abstract
Purpose
With the advent of newer diagnostic imaging tools, the reported prevalence of acute pulmonary embolism (PE) following total hip (THA) and total knee (TKA) arthroplasty appears to be increasing. However, the true prevalence and clinical relevance of these events are unclear. Our study was designed to evaluate the results of routine multi-detector computed tomography (MDCT) in this patient population in the early postoperative period.
Method
We prospectively performed MDCT scans on 48 consecutive THA/TKA patients on the first postoperative day in 2009. Patients underwent routine postoperative care and data were collected regarding the development of symptoms such as tachycardia, fever, chest pain, or shortness of breath. Scans were kept blinded and read at the end of study recruitment for the diagnosis of acute PE.
Results
Our cohort included 27 TKA patients and 21 THA patients. None of the 48 patients had any symptoms of PE. Among the TKR patients, 11 (41%) of the CT scans were read as positive for acute PE compared with 1 (5%) of the THR patients (p=0.004). All of the patients diagnosed with asymptomatic PE were discharged from hospital without treatment for venous thromboembolism (VTE) and without developing any clinical symptoms suggestive of VTE. One TKA patient, who had a negative CT scan on the first postoperative day, was diagnosed with symptomatic PE the following day.
Conclusion
Our study demonstrates a high rate of abnormal MDCT early following lower extremity arthroplasty, the clinical significance of which may be benign. This finding is also important in the interpretation of MDCT obtained after a clinical suspicion of PE in these patients.
