D-Dimer in the diagnosis of deep vein thrombosis following total hip and knee replacement: a prospective study

Authors: Rafee, A.¹; Herlikar, D.²; Gilbert, R.³; Stockwell, R.C.⁴; McLauchlan, G.J.⁵

Source: Annals of The Royal College of Surgeons of England, Volume 90, Number 2, March 2008 , pp. 123-126(4)

Publisher: The Royal College of Surgeons of England

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The Annals of The Royal College of Surgeons of England is the official journal of the College and is published eight times a year in January, March, April, May, July, September, October and November. The main aim of the journal is to publish high quality, peer-reviewed papers that relate to all branches of surgery.

The Annals also includes letters and comments, a regular technical section, NICE news, controversial topics, CORESS feedback, book reviews and the best trainee presentations from England and Wales. The editorial board is composed of members of the College Council and experts from across the surgical specialties.

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Abstract:

INTRODUCTION: The merit of using D-dimer estimations in patients following total hip and knee replacement has been previously questioned. A survey of radiology protocols in 70 hospitals ascertained that the test continues to be mandatory in 51 prior to formal radiological investigation of suspected deep vein thrombosis (DVT) in this patient population.

PATIENTS AND METHODS: In this study, D-dimer levels were measured pre-operatively and during the first 7 days following primary total hip and knee replacement to estimate the range of normal values in these patients.

RESULTS: All 78 patients were ultrasonographically shown to be clear of DVT. D-Dimer levels were significantly raised in all patients at all measurements during the first week. Levels after total knee replacement were higher than after total hip replacement. Comparison was made with an age-matched group who had a proven DVT. There was no difference in D-dimer levels between patients with or without a DVT.

CONCLUSIONS: The use of this test in this patient group is a waste of resource and merely delays appropriate radiological investigation and treatment.

Keywords: D-DIMER; DEEP VEIN THROMBOSIS; TOTAL HIP REPLACEMENT; TOTAL KNEE REPLACEMENT

Document Type: Research article

DOI: 10.1308/003588408X261627

Affiliations: 1: Manchester University, Manchester, UK 2: Furness General Hospital, Barrow-in-Furness, UK 3: Queen's Hospital, Burton-on-Trent, Staffordshire, UK 4: Department of Radiology, Chorley District General Hospital, Chorley, UK 5: Department of Orthopaedics, Chorley District General Hospital, Chorley, UK