Early diagnosis of deep vein thrombosis following total hip replacement using impedance plethysmography: advantages and limitations of this approach.
Early diagnosis of deep vein thrombosis (DVT) following total hip replacement is of fundamental importance given the particularly high incidence of thromboembolic complications and the limited effectiveness of available preventive measures. The authors report the results of postoperative monitoring of the lower limbs using impedance plethysmography (IPG). The validity of the computerized plethysmograph used in this study has been confirmed by previous clinical studies, in which this instrument demonstrated high sensitivity and specificity of diagnosis of deep vein thrombosis in the symptomatic patient. In the present study, however, the instrument is applied to a group of mostly asymptomatic patients, many of whom have non-occlusive DVT. One hundred thirty-two patients underwent IPG both one the day before surgery and on the seventh day after surgery. The postoperative IPG was positive in seven asymptomatic patients (5.3%). Proximal DVT was confirmed by phlebography in five patients (3.7%) and found to be absent in two patients (false positives: 1.5%), for a positive predictive value of 71%. IPG also found proximal DVT to be absent in three patients with postoperative signs and/or symptoms compatible with a thrombotic complication in the lower limbs. The character of the study did not permit collection of data as to IPG sensitivity in the asymptomatic patient, which is presumably quite lower than in the symptomatic patient. Therefore, phlebography remains the most reliable test for diagnosis of asymptomatic DVT. However, systematic monitoring by phlebography is not feasible for logistic, economic, and ethical reasons. Postoperative use of IPG may at least partially reduce the risks connected with thromboembolic complications.