Is routine Doppler sonography needed to detect deep vein thrombosis after total knee arthroplasty? A real-world comparison of two clinical pathways.

Abstract

Deep vein thrombosis (DVT) and pulmonary embolism (PE) remain important complications after total knee arthroplasty (TKA). While routine Doppler screening can detect asymptomatic DVTs, the benefit of these findings is uncertain. This study compared routine Doppler screening with symptom-guided imaging in an Asian TKA population. This was a retrospective review of patients who underwent primary TKA at a single tertiary centre between July 2017 and June 2021. Two diagnostic pathways were applied: Clinical Pathway 1 (CP1) with routine Doppler on postoperative day 6, and Clinical Pathway 2 (CP2) with imaging only for symptomatic patients. All patients received standardized pharmacologic and mechanical thromboprophylaxis. A total of 582 patients were included (282 in CP1, 300 in CP2). DVT was diagnosed in 6 patients (2.1 %) in CP1 and 1 patient (0.3 %) in CP2 (p = 0.061). All Doppler-detected DVTs were asymptomatic. PE occurred in 8 patients (2.8 %) in CP1 and 4 patients (1.3 %) in CP2 (p = 0.202). PE was strongly associated with symptoms, confirmed in 16.1 % of symptomatic patients compared with 1.2 % of asymptomatic patients (p < 0.001). No patient required readmission within 90 days for thromboembolic events. One case of pulmonary cement embolism was identified and was clinically silent. Routine Doppler after TKA detected more DVTs, but these were small, incidental, and had no impact on outcomes. PE was almost always linked with symptoms, and its incidence was similar in both pathways. Routine screening for all patients had little value, while a symptom-guided approach was more practical and clinically relevant.