ROUTINE POSTOPERATIVE DUPLEX ULTRASONOGRAPHY SCREENING AND MONITORINGFOR THE DETECTION OF DEEP-VEIN THROMBOSIS - A SURVEY OF 110 TOTAL HIPARTHROPLASTIES

The use of duplex ultrasonography for routine noninvasive screening, m onitoring, and management of deep venous thrombosis after total hip ar throplasty was evaluated. The reliability of duplex ultrasonography fo r detection of deep vein thrombosis was confirmed in an initial cohort of 51 total hip arthroplasty patients (102 lower extremities), demons trating 91% sensitivity, 98% specificity, and 97% accuracy when compar ed with venography. A second cohort of 110 total hip arthroplasty pati ents using pneumatic compression stockings and aspirin as deep vein th rombosis prophylaxis underwent screening duplex ultrasonography of bot h lower extremities on postoperative Day 4. Duplex ultrasonography scr eening showed 10 (9.1%) patients with proximal deep vein thrombosis an d 10 (9.1%) with distal deep vein thrombosis, all of whom were asympto matic. The 10 patients with proximal deep vein thrombosis on duplex ul trasonography were prescribed therapeutic anticoagulation. Duplex ultr asonography subsequently confirmed resolution of proximal deep vein th rombosis in these patients before discontinuation of anticoagulation; none developed symptomatic pulmonary embolism through 12-month clinica l 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; non e manifested symptomatic deep vein thrombosis or pulmonary embolism th rough 12-month clinical followup. The 90 patients with negative duplex ultrasonography results were followed clinically; 3 developed late sy mptomatic proximal deep vein thrombosis (1 of these later manifested p ulmonary embolism). Therefore, duplex ultrasonography was used after t otal hip arthroplasty for the following: (1) to screen routinely in th e hospital for asymptomatic proximal and distal deep vein thrombosis; (2) to monitor for potential propagation of distal to proximal deep ve in thrombosis; (3) to minimize exposure to therapeutic anticoagulation by confirming the absence of proximal deep vein thrombosis in 97 of 1 10 patients; and (4) to demonstrate the effectiveness of mechanical an d systemic deep vein thrombosis management by confirming the absence o r resolution of deep vein thrombosis in all 110 patients.