Pulmonary embolism following total knee arthroplasty in Taiwanese patients

BackgroundPulmonary embolism is a relatively uncommon, but serious, postoperative complication of hip and knee arthroplasty; however, little information is available about the prevalence of pulmonary embolism in Taiwan.MethodsWe report here a series of five patients who sustained a symptomatic pulmonary embolism after undergoing total knee arthroplasty (TKA). These patients were identified during a retrospective study of 1768 patients carried out between January 2007 and January 2010.ResultsFive (0.28%) patients who sustained a symptomatic pulmonary embolism after TKA were identified in a series of 1768 patients. The diagnosis was confirmed by computed tomography angiography findings in four patients and an increased d-dimer level in one patient. All the patients were women, with a mean age of 68.0 years (range 64–76 years). The average body mass index of these patients was 32.6 kg/m2 (24–38 kg/m2). Four patients underwent simultaneous bilateral TKA, and one patient who was undergoing unilateral TKA also underwent revision TKA for a previously treated contralateral knee. None of the patients had a history of pulmonary embolism, and none was given prophylaxis for venous thromboembolism. The time at which pulmonary embolism occurred ranged from 2 to 8 days in five patients. After treatment, no patient had died by the end of the follow-up period. These case reports highlight the equal incidence of pulmonary embolism after TKA in Taiwanese and Western populations.ConclusionSteps to prevent pulmonary embolism should be undertaken in selected patients, such as these patients with a high body mass index and simultaneous bilateral TKA.