Pulmonary embolism following total knee arthroplasty in Taiwanese patients

Po-Kuei Wu; Cheng-Fong Chen; Lien-Hsiang Chung; Chien-Lin Liu; Wei-Ming Chen

doi:10.1016/j.jcma.2013.11.005

Pulmonary embolism following total knee arthroplasty in Taiwanese patients

J Chin Med Assoc. 2014 Mar;77(3):155-9. doi: 10.1016/j.jcma.2013.11.005. Epub 2013 Dec 11.

Authors

Po-Kuei Wu¹, Cheng-Fong Chen², Lien-Hsiang Chung³, Chien-Lin Liu⁴, Wei-Ming Chen⁵

Affiliations

¹ Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
² Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
³ Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Orthopedics and Traumatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
⁴ Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
⁵ Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Orthopedic Department, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: ciaoquess@gmail.com.

PMID: 24332413
DOI: 10.1016/j.jcma.2013.11.005

Abstract

Background: Pulmonary embolism is a relatively uncommon, but serious, postoperative complication of hip and knee arthroplasty; however, little information is available about the prevalence of pulmonary embolism in Taiwan.

Methods: We report here a series of five patients who sustained a symptomatic pulmonary embolism after undergoing total knee arthroplasty (TKA). These patients were identified during a retrospective study of 1768 patients carried out between January 2007 and January 2010.

Results: Five (0.28%) patients who sustained a symptomatic pulmonary embolism after TKA were identified in a series of 1768 patients. The diagnosis was confirmed by computed tomography angiography findings in four patients and an increased d-dimer level in one patient. All the patients were women, with a mean age of 68.0 years (range 64-76 years). The average body mass index of these patients was 32.6 kg/m(2) (24-38 kg/m(2)). Four patients underwent simultaneous bilateral TKA, and one patient who was undergoing unilateral TKA also underwent revision TKA for a previously treated contralateral knee. None of the patients had a history of pulmonary embolism, and none was given prophylaxis for venous thromboembolism. The time at which pulmonary embolism occurred ranged from 2 to 8 days in five patients. After treatment, no patient had died by the end of the follow-up period. These case reports highlight the equal incidence of pulmonary embolism after TKA in Taiwanese and Western populations.

Conclusion: Steps to prevent pulmonary embolism should be undertaken in selected patients, such as these patients with a high body mass index and simultaneous bilateral TKA.

Keywords: anticoagulant drugs; pulmonary embolism; total knee arthroplasty; venous thromboembolism.

MeSH terms

Aged
Arthroplasty, Replacement, Knee*
Female
Humans
Middle Aged
Postoperative Complications*
Pulmonary Embolism / etiology*
Retrospective Studies