ABSTRACT
AIM: To assess the most accurate clinical signs and clinical scoring for selecting patients who could benefit from duplex sonography screening of deep venous thrombosis (DVT) after total hip replacement (THR) and total knee replacement (TKR). METHODS: Four hundred and eighty consecutive patients with THR or TKR were included. Post-operative physical examination and venous duplex sonography (day 6-10) were performed in all of them. DVT was diagnosed in presence of at least 3mm thick and 3 cm long incomplete venous compressibility. Clinical prediction scores were built from clinical parameters, which were significantly associated with DVT in univariate analysis, one of them weighted from logistic multivariate regression coefficients. RESULTS: Recent DVT was diagnosed in 74 patients (15.7%) (29.6% after TKR and 8.4% after THR). There was no isolated proximal DVT and extensive DVTs were very rare (TKR 1.2% vs. THR 1%). Two TKR patients developed pulmonary embolism (1.2%). One died (0.6%). Univariate analysis showed significant association between provoked localized limb pain, pitting edema and difference in calf circumference (DCC), and DVT (P<0.0001). DCC> 3 cm was significantly associated with DVT (32.4% vs. 16.6%, OR 2.4 [1.3-4.2] ; P=0.001). In multivariate analysis the only two clinical manifestations independently associated with DVT were provoked localized limb pain (adjusted OR 2.3 [1.3-4.1] ; P<0.01) and DCC> 3 cm (adjusted OR 2.0 [1.1-3.8] ; P=0.04). A clinical score value greater or equal to 4 was associated with a risk of DVT of 34%, and a value<4 with a risk of 9%. CONCLUSIONS: After THR or TKR, DCC> 3 cm or a clinical risk score greater or equal to 4 could be used as an accurate and easy clinical test for assessing the need for further DVT screening by sonography.
