• Yoshihisa Fujita, Hideki Nakatsuka, Yoshifumi Namba, Shigeru Mitani, Nami Yoshitake, Etsuko Sugimoto, and Keita Hazama.
• Departments of Anesthesiology and ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan, fujitay@med.kawasaki-m.ac.jp.
• J Anesth. 2015 Apr 1; 29 (2): 235-41.

PurposeThe true incidence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) events, and the predictive risk factors are not well-defined in patients who undergo major lower extremity arthroplasty such as total hip arthroplasty (THA) or total or partial knee arthroplasty (TPKA). Using multidetector computed tomography (MDCT), pulmonary angiography (CTA), and MDCT venography (CTV), we investigated the prevalence of VTE and its predictive risk factors in patients for whom the guideline recommends prophylaxis.MethodsThe electronic records of patients who underwent elective THA or TPKA at our institution from April 2010 through July 2013 were surveyed. We examined a total of 1,163 patient records for 986 patients who had undergone MDCT seven days after THA or TPKA.ResultsNo PE-related deaths occurred in this study, though arterial embolization was needed for major bleeding in two cases. CTA-CTV revealed VTE in 51 (4.4 %) patients, PE in 20 (1.7 %), and DVT in 43 (3.3 %). Five of 51 patients had symptoms suggestive of DVT. In the logistic regression model, the type of surgery (TPKA > THA), patient age, and body mass index (BMI) were identified as predictive risk factors for VTE.ConclusionsThis observational study showed that the overall incidence of VTE after THA and TPKA is 4.4 % in patients receiving recommended antithrombotic prophylaxis. TPKA is associated with a higher incidence of VTE than of THA, and greater BMI and older patient age are also independent risk factors.

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