Beuhler KO, D`Lima DD, Colwell CW Jr, Otis SM, Walker RH.
Venous thromboembolic disease after hybrid hip arthroplasty with negative duplex
screening.
Clin Orthop 1999 Apr;(361):168-77

Noninvasive Vascular Laboratory, Scripps Clinic, La Jolla, CA 92037, USA.

Postoperative duplex ultrasonography screening after total hip arthroplasty has
been shown to identify patients who may require treatment or additional
monitoring for venous thromboembolic disease. The potential for manifestation of
venous thromboembolic disease subsequent to screening remains a concern. The
objective of this study was to determine the prevalence of symptomatic venous
thromboembolic disease after total hip arthroplasty and after inhospital
prophylaxis, inhospital screening with negative results for proximal deep venous
thrombosis, and no posthospitalization venous thromboembolic disease prophylaxis.
One hundred fifty patients undergoing primary hybrid total hip arthroplasty and
using pneumatic compression stockings and aspirin as prophylaxis against venous
thromboembolic disease were screened for deep venous thrombosis with duplex
ultrasonography on the fourth day after surgery. Duplex ultrasonography screening
revealed 17 (11.3%) patients with asymptomatic proximal deep venous thrombosis.
In response to duplex ultrasonography screening, these patients with proximal
deep venous thrombosis received therapeutic anticoagulation. Of 133 patients with
a duplex screen with negative results for proximal deep venous thrombosis, 131
(98.5%) continued to have no symptoms of venous thromboembolic disease and two
(1.5%) began to have symptoms for venous thromboembolic disease (one with
proximal deep venous thrombosis, one with nonfatal pulmonary embolism) during 12
months of clinical followup after total hip arthroplasty. The overall prevalence
of venous thromboembolic disease requiring anticoagulation was 19 of 150 (12.6%)
patients. The remaining 131 (87.4%) were not exposed to the risks of
postoperative anticoagulation and did not have subsequent symptomatic venous
thromboembolic disease.