Pulmonary Embolism and its Prophylaxis Following the Charnley Total Hip Replacement

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

“…The incidence of fatal PE was as high as 2.2% (26 of 1174) in the 1960s [27]. The use of anticoagulation is believed to have reduced the incidence of symptomatic and fatal PE in the early era of total joint arthroplasty [10,27].…”

Limb Loss Following the Use of Heparin

“…Earlier advice recommending the routine use of heparin was based on the assumption that 2.3% to 3.4% of patients will suffer a fatal pulmonary embolism if not given pharmacological prophylaxis. 2 Recent studies, however, have shown that the incidence of fatal pulmonary embolism is only 0.1% to 0.34% 3,4 and that there is no conclusive evidence to suggest that a reduction in the frequency of venographically-detected deep-vein thrombosis would lead to a subsequent reduction in the death rate from pulmonary embolism. 5 In order to demonstrate this, a sample size of around 100 000 would be required since the incidence of fatal pulmonary embolism is so small.…”

Lung Complications After Elective Hip Surgery

“…Thus all pulmonary emboli are not detected with this screening method, on the seventh postoperative day. It has been shown that fatal pulmonary embolism can be delayed for several weeks after injury (Sevitt 1962, Johnson et al 1977. It is interesting to note that some patients with only very discreet changes in the scintigrams had clinical signs of pulmonary embolism.…”