title: Routine postoperative duplex ultrasonography screening and monitoring for the detection of deep vein thrombosis. A survey of 110 total hip arthroplasties.
abstract: The use of duplex ultrasonography for routine noninvasive screening, monitoring, and management of deep venous thrombosis after total hip arthroplasty was evaluated. The reliability of duplex ultrasonography for detection of deep vein thrombosis was confirmed in an initial cohort of 51 total hip arthroplasty patients (102 lower extremities), demonstrating 91% sensitivity, 98% specificity, and 97% accuracy when compared with venography. A second cohort of 110 total hip arthroplasty patients using pneumatic compression stockings and aspirin as deep vein thrombosis prophylaxis underwent screening duplex ultrasonography of both lower extremities on postoperative Day 4. Duplex ultrasonography screening showed 10 (9.1%) patients with proximal deep vein thrombosis and 10 (9.1%) with distal deep vein thrombosis, all of whom were asymptomatic. The 10 patients with proximal deep vein thrombosis on duplex ultrasonography were prescribed therapeutic anticoagulation. Duplex ultrasonography subsequently confirmed resolution of proximal deep vein thrombosis in these patients before discontinuation of anticoagulation; none developed symptomatic pulmonary embolism through 12-month clinical followup. The 10 patients with distal deep vein thrombosis diagnosed by duplex ultrasonography were not treated with anticoagulation, but were monitored by serial duplex ultrasonography through postoperative Day 14 for propagation of distal to proximal deep vein thrombosis; none manifested symptomatic deep vein thrombosis or pulmonary embolism through 12-month clinical followup. The 90 patients with negative duplex ultrasonography results were followed clinically; 3 developed late symptomatic proximal deep vein thrombosis (1 of these later manifested pulmonary embolism). Therefore, duplex ultrasonography was used after total hip arthroplasty for the following: (1) to screen routinely in the hospital for asymptomatic proximal and distal deep vein thrombosis; (2) to monitor for potential propagation of distal to proximal deep vein thrombosis; (3) to minimize exposure to therapeutic anticoagulation by confirming the absence of proximal deep vein thrombosis in 97 of 110 patients; and (4) to demonstrate the effectiveness of mechanical and systemic deep vein thrombosis management by confirming the absence or resolution of deep vein thrombosis in all 110 patients.
authors.affiliation: Division of Orthopaedic Surgery, Scripps Clinic and Research Foundation, La Jolla, CA 92037.
authors.forename: J C
authors.initials: JC
authors.lastname: Grady-Benson
authors.forename: C S
authors.initials: CS
authors.lastname: Oishi
authors.forename: P B
authors.initials: PB
authors.lastname: Hanson
authors.forename: C W
authors.initials: CW
authors.lastname: Colwell
authors.forename: S M
authors.initials: SM
authors.lastname: Otis
authors.forename: R H
authors.initials: RH
authors.lastname: Walker
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005676:Gravity Suits; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D010690:Phlebography; D011184:Postoperative Period; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013924:Thrombophlebitis / Q000000981:diagnostic imaging* / Q000517:prevention & control; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D000925:Anticoagulants; D001241:Aspirin