title: CT pulmonary angiography and pulmonary embolism following 5809 primary joint arthroplasties.
abstract: OBJECTIVE
  Controversy surrounds prevention, detection and clinical relevance of pulmonary embolism (PE) following arthroplasty in orthopaedic patients. We aimed to review the rates of computer tomography pulmonary angiography (CTPA), PE and fatal PE following total joint replacement.
  
  
  METHODS
  Mixed retrospective/prospective review of CTPA requests and PE incidence amongst patients undergoing primary knee and hip arthroplasty.
  
  
  RESULTS
  The overall PE rate was 112/5809 (1.93%): 38/3473 (1.1%) and 74/2336 (3.5%) following total hip arthroplasty (THA) and total knee arthroplasty (TKA), respectively. Two deaths from PE occurred, both after TKA, a procedural mortality rate of 0.086%; the overall mortality rate was 0.034%. The rate of CTPA requests increased for the initial 7 years as did the rate of PE, in the last 2 years both rates fell.
  
  
  CONCLUSIONS
  The findings are discussed in context of published data and with reference to studies suggesting the high sensitivity of CTPA may over diagnose clinically significant PE following arthroplasty if ordered without a robust method of determining the pre-test probability.
authors.affiliation: Orthopaedic Department, Christchurch Hospital, PO Box 5445, Christchurch, New Zealand. charlotte.allen@gmail.com.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Allen
authors.forename: Richard
authors.initials: R
authors.lastname: Seinge
authors.forename: Rod
authors.initials: R
authors.lastname: Maxwell
authors.forename: Dilraj
authors.initials: D
authors.lastname: Thind
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D004434:Early Ambulation; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed