Thromboembolic disease after total knee replacement: experience of 5100 cases.

The aim of the study was to quantify the incidence and timing of venous thromboembolic events (VTE) after total knee replacement (TKR). Data from 5100 consecutive TKRs performed over 10 years were prospectively collected. Cases were reviewed to identify thromboprophylaxis given, the diagnosis of VTE, treatment and adverse outcomes. There were 3 deaths (0.059%) from pulmonary embolism (PE). Of 123 VTEs identified, 55 had PE, 17 had above knee deep vein thrombosis (DVT), 28 had calf DVT and 14 had been incorrectly coded as VTE. There was considerable inappropriate treatment of calf DVT with resultant morbidity. There was an increase in diagnosis of PE between days 1 and 5 post surgery in the later part of the study, corresponding with increasing use of CT Pulmonary Angiography. Increasing diagnosis of PE may be due to detection of embolic debris from surgery due to greater vigilance rather than post-operative thromboembolism. Death from PE is rare following TKR.