Abstract
Introduction
Total knee arthroplasty (TKA) is one of the most successful surgeries to relieve pain and dysfunction caused by severe arthritis. However, it is a still big problem that there is a possibility of death in pulmonary embolism (PE) after TKA. We previously reported that there was more incidence of asymptomatic PE than estimated in general by detail examinations. But it was difficult to whom we decided to perform additional examinations except the patients with some doubtful symptoms. Therefore, we investigated detail of PE patients after primary TKA to find out anything key point in PE.
Methods
Consecutive ninety-nine patients who underwent primary TKA from January 2015 to March 2018 were applied. There were 23 male and 76 females included, and the mean age was 73.7 years old. There were 96 cases of osteoarthritis, 2 cases of osteonecrosis and one of rheumatoid arthritis. A single knee surgery team performed all operations with cemented type prostheses and air tourniquet during operation. There were 35 cases of one-staged bilateral TKA and 64 of unilateral TKA. Detail examinations with contrast enhanced CT (CE-CT) and venous ultrasonography (US) were performed at the 3rd day after surgery. Next, we applied ultra sound cardiogram (UCG) to the patients diagnosed as PE by CE-CT, we checked right ventricular overload (RVO) to treat PE. These images were read by a single senior radiologist team.
Results
CE-CT was performed in 87 patients (87.8%) and US was in all patients. The incidence of deep vein thrombosis (DVT) was 67 patients (67.6%), and all of these was distal type DVT. PE was 17 patients (17.1%), and each of patients had no symptoms. RVO was detected in 5 patients (5.0%), and two of them (2.0%) had decreased SpO2 in early 90% perioperative period. All patients did not change rehabilitation protocol and progress was good until discharge.
Conclusion
We investigated consecutive 99 patients for DVT/PE after primary TKA using CE-CT and venous US. And we performed UCG to PE patients. One of the important findings to decide detail examination for asymptomatic PE was decrease in SpO2 during early perioperative period. It might be the only finding except symptom. We also have to be more aware about high incidence of asymptomatic PE and more careful to the patients after TKA to prevent complications.
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