Ultrasonographic Screening of Deep Venous Thrombosis in Patients Undergoing Total Hip Replacement

Abstract

The incidence of deep venous thrombosis (DVT) after total hip replacement is estimated to be up to 45%. Venography is widely accepted as the gold standard procedure for diagnosis of DVT. With the purpose of detecting the presence of DVT in asymptomatic patients operated on for primary hip replacement, we adopted Real-time B-Mode ultrasonography in order to evaluate its specificity and sensitivity in 68 patients. A venography was performed in all the cases in order to obtain a gold standard to compare with sonography. Sensitivity and specificity of sonography for femoral thrombosis were 71.4% and 97.6% respectively. Ultrasounds were not able to detect thrombosis of the calf veins but the risk of an evolution to worse pulmonary embolism is quite insignificant at this level. We suggest the use of B-mode ultrasonography for DVT screening of lower limbs in all the patients undergoing total hip replacement.

Keywords

Venous thrombosis Hip arthroplasty Ultrasonography

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References

Atti del XXIII Congresso della Società Internazionale di Trombosi ed Emostasi. 1991.

Cranley

J.J.

The deep vein thrombosis. Fallibility of clinical signs and symptoms. Arch Surg 1976; 111: 34–6.

Woolson

S.T.

B-Mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement. J Bone Joint Surg (A) 1990; 72A: 983–7.

Buller

H.R.

Deep vein thrombosis: new non-invasive diagnostic tests. Thrombosis and haemostasis 1991; 66: 133–7.

Borris

L.C.

Comparison of real-time B-Mode ultrasonography and bilateral ascending phlebography for detection of postoperative deep vein thrombosis following elective hip surgery. Thrombosis and haemostasis 1989; 61: 363–5.

Aitken

A.G.F.

, Godden

D.J.

Real-time ultrasound diagnosis of deep vein thrombosis: a comparison with venography. Clinical Radiology 1987; 38: 309–13.

Nagesh Raghavendra

Deep venous thrombosis: detection by probe compression of veins. J Ultrasound Med 1986; 5: 89–95.

Rabinov

, Paulin

Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134–44.

Cruickshank

M.K.

An evaluation of impedance plethysmography and ¹²⁵I-Fibrinogen leg scanning in patients following hip surgery. Thrombosis and haemostasis 1989; 62: 830–4.

10.

Hull

Diagnostic efficacy of impedance plethysmography for clinical suspected deep vein thrombosis. Ann Intern Med 1985; 53: 696–700.

11.

Agnelli

Diagnostic accuracy of the computerized impedance plethysmography in the diagnosis of symptomatic deep vein thrombosis: a venography controlled study. Angiology 1990; 41: 559–64.

12.

Agnelli

Impedance plethysmography in the diagnosis of asymptomatic deep vein thrombosis in hip surgery: a venography controlled study. Arch Intern Med 1991; 151: 2167–71.

13.

Dauzat

M.M.

Real-time B-Mode ultrasonography for better specificity in the noninvasive diagnosis of deep vein thrombosis. J Ultrasound Med 1986; 5: 625–31.

14.

Leising

A.W.A.

Detection of deep vein thrombosis by real-time B-Mode ultrasonography. N Engl J Med 1989; 320: 342–5.

15.

Ginsberg

J.S.

Compression ultrasonography and impedance plethysmography for detection of venous thrombosis in patients who have undergone major hip or knee surgery. Thrombosis and Haemostasis 1991; 65: 1173.

16.

Agnelli

Detection of asymptomatic deep vein thrombosis by Real-time B-Mode ultrasonography in hip surgery patients. Thrombosis and haemostasis 1992; 3: 257–60.

17.

Sevitt

Venous thrombosis and pulmonary embolism. Amer J Med 1962; 33: 703–4.

18.

Mavor

G.E.

The ileofemoral venous segment as a source of pulmonary emboli. Lancet 1967; 1: 871–4.

19.

Mavor

G.E.

Ileofemoral venous thrombosis: pathological considerations and surgical management. Brit J Surg 1969; 56: 45–59.

20.

Moser

K.M.

Embolic risk conditioned by location of deep venous thrombosis?

Am Intern Med 1981; 94: 439–44.

21.

Stamatakis

J.D.

Femoral vein thrombosis and total hip replacement. Br Med J 1977; 2: 223–5.