Introduction: Pulmonary embolism (PE) is a potentially fatal complication of total joint arthroplasty (TJA). Therefore, reliable means for diagnosis and evaluation of severity is essential. This study evaluates the reliability of common clinical signs and symptoms in the diagnosis of PE. In addition, clinical presentation is correlated with size and location of emboli within the pulmonary vasculature (segmental, lobar, or main).

Methods: The clinical and imaging records of all patients with confirmed diagnosis of PE following TJA performed between 2000 and 2004 were reviewed in detail. The mode of presentation and the subsequent imaging findings were noted.

Results: A total of 132 confirmed PE cases were studied. Clinical presentation included dyspnea (19.7%), chest pain (7.6%), change of mental status (6.8%0, hypotension (6.1%), and diaphoresis (3.8%). Mean room air pulse-oximetry was 85.5%. Arterial sampling showed mean O2 saturation of 88.1% and pO2 of 58.7. There was not a direct correlation between the size of the PE and the clinical presentation. However, there was a correlation between the severity of oxygen desaturation and the size and location of the embolus.

Conclusions: The presentation of PE can be non-specific and highly variable ranging from mild dyspnea to catastrophic hemodynamic collapse. Common clinical signs have a low sensitivity for diagnosis and do not correlate with severity of disease. The only correlation seemed to be measured arterial O2 saturation and pressure. Thresholds for the diagnosis of clinically significant pulmonary embolisms need to be established to improve management of this important condition.