The incidence of deep vein thrombosis and pulmonary embolism after total knee arthroplasty: the screening study by radionuclide venography.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are considered uncommon in Asian populations and thrombo-prophylaxis is rarely indicated. The objective of this study was to investigate the incidence of DVT and PE after total knee replacement in an Asian population. MATERIAL AND METHOD: There were 100 patients who underwent total knee replacement enrolled in this study. No thrombo-prophylaxis was given to these patients. The possible risk factors such as age, sex, body mass index (BMI), operative time and the post-operative blood loss were recorded. RESULTS: The duplex ultrasonography (controlled) showed no evidence of DVT in all cases. There were 67 patients who completed radionuclide venography in this study. The incidence of DVT from positive radionuclide venography was 24% (16/67 patients) and PE was 12% (8/67 patients). All patients with positive imaging studies were asymptomatic. The risk factors were similar in both groups. CONCLUSION: The incidence of DVT and PE in post-operative total knee replacement surgery, although lower than the incidence in Western populations, is higher than previously assumed. The radionuclide venography is less invasive and a useful diagnostic method for both DVT and PE. Because all patients with DVT and PE are asymptomatic, the use of thrombo-prophylaxis should be considered for risk and benefit.

Meniscal lesions in the anterior cruciate insufficient knee: the accuracy of clinical evaluation.

OBJECTIVE: The purpose of this study was to find out the accuracy of certain symptoms and examination findings that are used to diagnose meniscal injury associated with a torn anterior cruciate ligament. STUDY DESIGN: Cross-sectional study. MATERIAL AND METHOD: The authors studied one hundred consecutive patients with anterior cruciate ligament insufficiency who were scheduled for surgery. During preoperative admission, one of the authors (KT) examined the patients and recorded the demographic data, duration of symptoms, and the clinical findings including Ballottement sign, joint line tenderness, Childress' sign, Merke's sign, Steinmann I sign, McMurray test, and Apley test. All patients underwent arthroscopically assisted anterior cruciate reconstruction by the senior author (PC). Specific meniscal procedures were performed according to the surgeon's preference at the time of surgery. Predictive results of preoperative examination tests for meniscal tears were compared with the findings at surgery and analyzed using arthroscopic findings as the gold standard. RESULTS: There were one hundred patients included in the present study. Out of 100 patients, 75% had meniscal tears and 6% had both meniscal and cartilage lesions. The most sensitive test was Childress' sign (68%), which also had the highest accuracy (66%). The most specific tests were Steinmann I sign and Apley test (100%). CONCLUSION: Childress' sign was more accurate than other tests for detecting meniscal lesions in anterior cruciate insufficient knees. Steinmann I sign and Apley test had the highest specificity.