American Academy of Orthopaedic Surgeons

View all recommendations from this society

Released September 11, 2013

Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.

Since ultrasound is not effective at diagnosing unsuspected deep vein thrombosis (DVT) and appropriate alternative screening tests do not exist, if there is no change in the patient’s clinical status, routine post-operative screening for DVT after hip or knee arthroplasty does not change outcomes or clinical management.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Orthopaedic Surgeons (AAOS) routinely develops evidence-based clinical practice guidelines as valuable tools to advance the physician-patient communications process and enhance the diagnosis and treatment of musculoskeletal conditions. AAOS physician volunteer work groups develop evidence-based clinical practice guidelines to serve as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment. The most recent approved clinical practice guidelines have been published in the Journal of Bone and Joint Surgery. AAOS staff, led by the medical director, conducted a review of the approved clinical practice guidelines previously developed by the work groups and selected a variety of topics frequently used in orthopaedic surgical practice. After input from the orthopaedic specialty society leaders and approval from the AAOS Presidential Leadership and Board of Directors, the final five topics were selected for this campaign. The AAOS disclosure and conflict of interest policy can be found at www.aaos.org.

Sources

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American Academy of Orthopaedic Surgeons. Clinical Practice Guideline on Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty. Rosemont (IL): American Academy of Orthopaedic Surgeons, 2011 Sep. Available from: http://www.aaos.org/research/guidelines/VTE/VTE_full_guideline.pdf.

Bounameaux H, Miron MJ, Blanchard J, de Moerloose P, Hoffmeyer P, Leyvraz PF. Measurement of plasma D-dimer is not useful in the prediction or diagnosis of postoperative deep vein thrombosis in patients undergoing total knee arthroplasty. Blood Coagul Fibrinolysis. 1998;9(8):749-52.

Ciccone WJ II, Fox PS, Neumyer M, Rubens D, Parrish WM, Pellegrini VD Jr. Ultrasound surveillance for asymptomatic deep venous thrombosis after total joint replacement. J Bone Joint Surg Am. 1998;80(8):1167-74.

Davidson BL, Elliott CG, Lensing AW, The RD Heparin Arthroplasty Group. Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. Ann Intern Med. 1992;117(9):735-8.

Garino JP, Lotke PA, Kitziger KJ, Steinberg ME. Deep venous thrombosis after total joint arthroplasty: the role of compression ultrasonography and the importance of the experience of the technician. J Bone Joint Surg Am. 1996;78(9):1359-65.

Larcom PG, Lotke PA, Steinberg ME, Holland G, Foster S. Magnetic resonance venography versus contrast venography to diagnose thrombosis after joint surgery. Clin Orthop Relat Res. 1996;(331):209-15.

Lensing AW, Doris CI, McGrath FP, Cogo A, Sabine MJ, Ginsberg J, Prandoni P, Turpie AG, Hirsh J. A comparison of compression ultrasound with color Doppler ultrasound for the diagnosis of symptomless postoperative deep vein thrombosis. Arch Intern Med. 1997;157(7):765-8.

Mont MA, Jacobs JJ, Boggio LN, Bozic KJ, Della Valle CJ, Goodman SB, Lewis CG, Yates AJ, Watters WC, Turkelson CM, Wies JL, Donnelly P, Patel N, Sluka P. AAOS clinical practice guideline summary preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. JAAOS. 2011Dec;19(12):768–76.

Niimi R, Hasegawa M, Sudo A, Shi D, Yamada T, Uchida A. Evaluation of soluble fibrin and D-dimer in the diagnosis of postoperative deep vein thrombosis. Biomarkers. 2010;15(2):149-57.

Pellegrini VD Jr, Donaldson CT, Farber DC, Lehman EB, Evarts CM. The John Charnley Award: prevention of readmission for venous thromboembolic disease after total hip arthroplasty. Clin Orthop Relat Res. 2005;441:56-62.

Pellegrini VD Jr, Donaldson CT, Farber DC, Lehman EB, Evarts CM. The Mark Coventry Award: prevention of readmission for venous thromboembolism after total knee arthroplasty. Clin Orthop Relat Res. 2006;452:21-7.

Robinson KS, Anderson DR, Gross M, Petrie D, Leighton R, Stanish W, Alexander D, Mitchell M, Flemming B, Gent M. Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: the post-arthroplasty screening study. A randomized, controlled trial. Ann Intern Med. 1997 Sep 15;127(6):439-45.

Schmidt B, Michler R, Klein M, Faulmann G, Weber C, Schellong S. Ultrasound screening for distal vein thrombosis is not beneficial after major orthopedic surgery. A randomized controlled trial. Thromb Haemost. 2003;90(5):949-54.

Westrich GH, Schneider R, Ghelman B, et al. Comparison between color Doppler imaging and ascending venography in the detection of deep venous thrombosis following total joint arthroplasty: a prospective study. Contemp Surg 1997;51:225-34.