The use of spiral computed tomography scans for the detection of pulmonary embolism.
Total joint arthroplasty carries a risk of symptomatic pulmonary embolism (PE). This study examined symptoms and risk factors of patients who underwent postoperative spiral computed tomography (CT) scans. The presenting symptoms and risk factors of total hip arthroplasty and total knee arthroplasty patients who had a postoperative CT scan were reviewed and the location of PE/deep vein thrombosis (DVT) was noted for positive scans. Of the 10209 patients who had total hip or total knee arthroplasty, 478 (4.7%) underwent a spiral CT scan to rule out PE and 136 (1.3%) had scans positive for PE. Twenty-two and four tenths percent of scans were positive for PE only, 2.1% for proximal DVT only, and 6.1% for PE and proximal DVT. Patients taking estrogen and patients presenting with low oxygen saturation postoperatively were significantly (P = .010, P < .001) more likely to have a positive scan. Spiral CT is the gold standard for detection of PE. Thirty-one and one half percent of scans were positive for PE and/or DVT, yet only 19.2% of patients had a predisposing risk factor for PE. Total knee arthroplasty carried a greater risk for PE than THA.
Kim
Han Jo
HJ
Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA.
Walcott-Sapp
Sarah
S
Leggett
Kristi
K
Bass
Anne
A
Adler
Ronald S
RS
Pavlov
Helene
H
Westrich
Geoffrey H
GH
D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D004967:Estrogens / Q000009:adverse effects; D006801:Humans; D010100:Oxygen; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012307:Risk Factors; D013923:Thromboembolism / Q000000981:diagnostic imaging; D036542:Tomography, Spiral Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging
D004967:Estrogens; D010100:Oxygen