Background: Thromboembolic disease in the form of deep venous
thrombosis and pulmonary embolism is a risk following hip and knee joint
replacement. Prophylactic and screening protocols have been employed to
prevent thromboembolic disease following lower extremity joint reconstruction.
The purpose of the present study was to evaluate two noninvasive venous
screening protocols, specifically, compression ultrasonography performed
either at the time of hospital discharge or two weeks after the operation.
Methods: From 1994 through 2001, 2364 patients undergoing primary
unilateral total hip or total knee arthroplasty were managed with an
anticoagulation chemoprophylaxis protocol (adjusted-dose warfarin) until the
time of noninvasive venous screening with use of one of two protocols. Nine
hundred thirty-one patients (406 hips and 525 knees) underwent compression
ultrasonography prior to hospital discharge, and the other 1433 patients (614
hips and 819 knees) underwent ultrasonographic screening two weeks after the
Results: Twenty-three proximal deep venous thromboses (prevalence,
2.5%) were identified in the group that underwent ultrasound screening at the
time of hospital discharge, and thirty-one proximal thromboses (prevalence,
2.2%) were identified in the group that underwent ultrasound screening two
weeks after the operation. There was no significant difference between the two
protocols with regard to the detection of deep venous thrombosis.
Conclusions: There was no significant difference between the group
that received two weeks of warfarin chemoprophylactic prophylaxis and the
group that was screened at the time of hospital discharge with regard to the
detection of deep venous thrombosis with use of compression ultrasound. On the
basis of these findings, we no longer screen asymptomatic patients for deep
venous thrombosis following hip and knee replacement, and all patients receive
warfarin anticoagulation for two weeks.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.