Accuracy of screening compression ultrasonography and clinical examination for the diagnosis of deep vein thrombosis after total hip or knee arthroplasty.
OBJECTIVE
To determine whether compression ultrasonography or clinical examination should be considered as screening tests for the diagnosis of deep vein thrombosis (DVT) after total hip or knee arthroplasty in patients receiving warfarin prophylaxis postoperatively.


METHODS
A prospective cohort study.


METHODS
A single tertiary care orthopedic centre.


METHODS
One hundred and eleven patients who underwent elective total hip or knee arthroplasty were enrolled. Postoperatively the warfarin dose was adjusted daily to maintain the international normalized ratio between 1.8 and 2.5. Eighty-six patients successfully completed the study protocol.


METHODS
Before they were discharged from hospital, patients were assessed for DVT by clinical examination, bilateral compression ultrasonography of the proximal venous system and bilateral contrast venography.


RESULTS
DVT was found in 29 patients (34%; 95% confidence interval [CI] 24% to 45%), and 6 patients (7%; 95% CI 3% to 15%) had proximal DVT. DVT developed in 18 (40%) of 45 patients who underwent total knee arthroplasty and in 11 (27%) of 41 patients who underwent total hip arthroplasty. The sensitivity of compression ultrasonography for the diagnosis of proximal DVT was 83% (95% CI 36% to 99%) and the specificity was 98% (95% CI 91% to 99%). The positive predictive value of compression ultrasonography was 71%. In contrast, clinical examination for DVT had a sensitivity of 11% (95% CI 2% to 28%) and a positive predictive value of 25%.


CONCLUSIONS
DVT is a common complication after total hip or knee arthroplasty. Compression ultrasonography appears to be a relatively accurate noninvasive test for diagnosing postoperative proximal DVT. In contrast, clinical examination is a very insensitive test. Whether routine use of screening compression ultrasonography will reduce the morbidity of venous thromboembolism after joint arthroplasty requires confirmation in a prospective trial involving long-term follow-up of patients.
Robinson
K S
KS
Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS.
Anderson
D R
DR
Gross
M
M
Petrie
D
D
Leighton
R
R
Stanish
W
W
Alexander
D
D
Mitchell
M
M
Mason
W
W
Flemming
B
B
Fairhurst-Vaughan
M
M
Gent
M
M
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D008297:Male; D010808:Physical Examination; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013924:Thrombophlebitis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D014463:Ultrasonography; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin