Use of the Greenfield filter to prevent fatal pulmonary embolism associated with total hip and knee arthroplasty.

We inserted a Greenfield filter prophylactically in forty-two of approximately 4,000 patients who were about to have a total hip or knee replacement, or both, and who were at high risk for pulmonary embolism (Group I). The filter was implanted postoperatively in twenty-four additional patients who had thromboembolic complications or in whom anticoagulation was contraindicated (Group II). None of the patients in Group I and only one in Group II had a fatal pulmonary embolism. Use of the Greenfield filter is a safe, easy, and effective method of preventing fatal pulmonary embolism in selected patients: those who are at exceptionally high risk for thromboembolism, as a method of preoperative prophylaxis; those who have had a thromboembolism and in whom therapeutic anticoagulation is contraindicated; and those who have complications secondary to therapeutic anticoagulation.