Symptomatic and asymptomatic deep vein thrombosis after total hip replacement. Differences in phlebographic pattern, described by a scoring of the thrombotic burden

The aim was to describe the phlebographic pattern of asymptomatic and sympt omatic deep vein thrombosis (DVT) after total hip replacement by the use of a scoring system in 102 consecutive patients (54 asymptomatic, 48 symptoma tic), The DVTs were scored from 1 to 3, and registered in a scoring system dividing the deep veins into 12 separate segments. The asymptomatic patient s had a significantly lower total mean DVT score of 3.7 compared to 9.1 in the symptomatic group of patients, The mean ratio of the DVT scores in the deep muscle veins in conjunction with the superficial femoral vein in relat ion to the total mean score was significantly higher in the asymptomatic pa tients (74.9%) compared to the symptomatic group (62.4%). A direct sign of DVT, displayed as a filling defect, was seen on the phlebogram in 116 of th e 119 legs, and concomitant nonfilling in other vein segments was noted in 6% of the asymptomatic patients, while in the symptomatic group this was th e case to a significantly higher level, namely, 46%. A subgroup of asymptom atic patients operated unilaterally, with bilateral DVT had a significantly higher total mean DVT score on the operated side (4.6) compared to the uno perated side (3.4). The total mean DVT score increased with time after surg ery (Spearman Correlation Coefficient = 0.46, r(2) = 0.22%) in the group of symptomatic patients. A low total mean DVT score with a predominance of DV T in, or in the connection to, the deep muscle veins is displayed among the asymptomatic patients. This is significantly different from the symptomati c patients who have more extensive DVTs, especially when diagnosed several weeks postoperatively, and frequently with edema and occlusive DVT. (C) 200 0 Elsevier Science Ltd. All rights reserved.