Controversy: Should All Patients Undergoing TJA Receive Pre- and Postoperative Ultrasound Screening for Detection of DVT?

Venous thromboembolism represents a frequent complication following total joint arthroplasty (TJA). Many international guidelines for deep venous thrombosis (DVT) prophylaxis do not recommend a preoperative lower limb duplex ultrasound before total hip and knee arthroplasty. This study is aimed at determining whether a preoperative Doppler ultrasonographic screening is cost-effective as a DVT and pulmonary embolism prevention device. A series of 2,678 consecutive patients undergoing TJA received preoperative assessment for DVT by bilateral lower limbs color Doppler ultrasonography. The study group included 1,697 females (63.3 %) and 981 males (36.7 %): All patients were included regardless of absence of previous vascular symptoms. Assessment included examination of bilateral common femoral, superficial femoral, popliteal, anterior tibial and posterior tibial veins. Preoperative ultrasound screening highlighted the presence of DVTs in 120 patients (4.5 %). Those patients were withdrawn from the operative schedule and began DVT treatment with personalized doses of LMWH (low molecular weight heparin). Patients underwent TJA procedure once the preoperative Doppler ultrasonography revealed absence of DVT (minimum 3 months; maximum 6 months). This study discovered a preoperative asymptomatic DVT in a consistent number of patients just before undergoing TJA: Without screening they were at risk of developing possible life-threatening perioperative pathologies. Therefore we consider it prudent to perform a preoperative Doppler ultrasonography to detect any pre-existing DVT, especially in patients who are considered to be at high risk.