Prophylactic and early therapeutic use of the Greenfield filter in hip and knee joint arthroplasty.

The orthopaedic literature does not provide clear guidelines for the protection of the extremely high-risk thromboembolic patient undergoing hip and knee total joint or related reconstructive surgery. Nor is there agreement of how to protect the immediate postoperative patient with thromboembolic complications. The authors, believing that routine anticoagulation measures are ill-advised in these two circumstances, elected instead to place a Greenfield vena cava filter for prevention of life-threatening thromboembolism. Using prospective selection criteria, 47 patients could be followed over a 24-76-month period. There were no clinical embolic episodes in either group and no late complications of the filter placement. The few complications in this series were related to insertion, only one of which lead to minor long-term disability. The caval patency rate was 96%. The authors have concluded that such prophylactic use of the Greenfield vena cava filter is justified since it contributes to safer and more reliable total hip and total knee surgery with only minor morbidity.