Abstract
Objective: Lower limb joint arthroplasty poses a high risk of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE). Careful clinical follow-up for DVT is required, but the period over which DVTs disappear remains to be elucidated. The purpose of this study was to investigate the disappearance period of DVTs by ultrasonography of the lower extremities and measurement of D-dimer levels.
Methods: We prospectively evaluated 134 joints in 109 patients who underwent lower limb joint arthroplasty between June 2008 and September 2010; procedures included total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and total hip arthroplasty (THA). Measurement of D-dimer levels and ultrasonographic evaluation of the lower extremities were performed preoperatively and on the first and seventh postoperative days. Ultrasonography was also carried out periodically thereafter, and the disappearance period of DVTs was evaluated by ultrasonography. For physical thromboprophylaxis, we used graduated compression stockings (GCS) and intermittent pneumatic compression (IPC). Furthermore, subcutaneous injection of fondaparinux (2.5 mg/day) was done for pharmacological prevention.
Results: Preoperative DVT was found in 5 of 20 joints; all were distal DVTs. Mean D-dimer levels preoperatively and on the first and the seventh days were 1.1 (0.34.2), 8.6 (217.9), and 10.1 (2.353.9) mg/ml, respectively. Twenty (14.9%) of 134 joints were found to have DVT. DVT disappeared in 13 of 20 joints; the mean disappearance period of DVT was 7.5 months postoperatively. There were no patients with PTE. Only one patient had clinical symptoms of DVT, i.e., swelling of the lower leg. The other patients had no symptoms.
Conclusion: In this study, DVT relating to lower limb arthroplasty had disappeared 7.5 months after surgery. Postoperative ultrasonography of lower extremities was effective for evaluation of DVT.
