The Rise in the Incidence of Pulmonary Embolus after Joint Arthroplasty
- 1 October 2007
- journal article
- section ii
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research
- Vol. 463, 107-113
- https://doi.org/10.1097/blo.0b013e318145af41
Abstract
In recent years, there has been an apparent increase in the incidence of pulmonary embolus after joint arthroplasty at our institution. We hypothesized the use of sophisticated imaging modalities such as the multidetector computed tomography scan, with better sensitivity, resulted in an apparent increase in the incidence of pulmonary embolus. We studied all patients with pulmonary embolus after joint arthroplasty between 2000 and 2005. The incidence of pulmonary embolus increased from 0.21% (six of 2859) when VQ scan was the modality of choice to 0.98% (50 of 5095) during the time spiral computed tomography was used to 1.72% (89 of 5179) in recent years when multidetector computed tomography was used. Despite the apparent increase in pulmonary embolus, we observed no change in mortality during the study period. Surgeons should be aware of the challenges sophisticated imaging modalities in general and modern imaging introduce for pulmonary embolus in particular. Extremely sensitive imaging tests with unknown specificity have resulted in an increase in diagnosed pulmonary embolus. However, diagnosing pulmonary embolus generates implications for further treatment such as prolonged anticoagulation and/or inferior vena cava filter insertion with potential for catastrophic complications. The challenge is to distinguish which require treatment and which do not. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.Keywords
This publication has 45 references indexed in Scilit:
- Multidetector pulmonary CT angiography: advances in the evaluation of pulmonary arterial diseasesSeminars in Ultrasound, CT and MRI, 2004
- Diagnosis of Acute Pulmonary Embolism in Outpatients: Comparison of Thin-Collimation Multi–Detector Row Spiral CT and Planar Ventilation-Perfusion ScintigraphyRadiology, 2003
- Short-Duration Prophylaxis Against Venous Thromboembolism After Total Hip or Knee ReplacementArchives of Internal Medicine, 2002
- Thromboembolic complications after total hip replacementInternational Orthopaedics, 2002
- Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trialsThe Lancet, 2001
- Prevention of Venous Thromboembolic Disease Following Primary Total Knee ArthroplastyJournal of Bone and Joint Surgery, 2001
- Pulmonary Embolism Revealed on Helical CT AngiographyAmerican Journal of Roentgenology, 2000
- Spiral Computed Tomography Is Comparable to Angiography for the Diagnosis of Pulmonary EmbolismAmerican Journal of Respiratory and Critical Care Medicine, 2000
- Comparison of Enoxaparin and Warfarin for the Prevention of Venous Thromboembolic Disease After Total Hip Arthroplasty. Evaluation During Hospitalization and Three Months After Discharge*The Journal of Bone & Joint Surgery, 1999
- Incidence of fatal pulmonary embolism after 1,390 knee arthroplasties without routine prophylactic anticoagulation, except in high-risk casesThe Journal of Arthroplasty, 1997