Abstract
The reported incidence of deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA) and hip fracture surgery is 40-60%, and data indicate that about 32% of patients die after developing symptomatic pulmonary thromboembolism (PTE). We performed revision-THA on a patient with alcoholic liver cirrhosis who had developed osteolysis after femoral head replacement at another hospital 15 years previously. The operation, taking 90 minutes, had involved only cup replacement via the posterior approach, and the intraoperative blood loss had been about 1300 ml. The patient started walking exercise on the following day, and was able to walk independently with a walker in the ward at seven days after surgery. The D-dimer level at one week after surgery was 16.8μg/ml, and angiographic computed tomography (CT) showed DVT in the anterior tibial veins of the affected leg and PTE in both inferior lobar branches of the pulmonary artery. We started anticoagulant therapy, and inserted an inferior vena cava filter on the following day. An angiographic CT reexamination one week later showed that the DVT was reduced and PTE had disappeared. This case did not require postoperative anticoagulant drugs because of the patient's bleeding tendency due to hepatic cirrhosis. Careful attention was required in this case, because asymptomatic PTE occurred despite the patient's bleeding tendency and early rehabilitation after the operation.
