Clinical Presentation of Pulmonary Embolus After Total Joint Arthroplasty: Do Size and Location of Embolus Matter?

Pulmonary embolism (PE) is a potentially fatal complication of total joint arthroplasty. Therefore, it is essential to have reliable means for diagnosis and evaluation of severity.

In the study reported here, we evaluated the reliability of common clinical signs and symptoms in the diagnosis of PE. In addition, we used correlation analysis to assess for a correlation between clinical presentation and size and location of the embolus within the pulmonary vasculature. Included in this study were 13,133 patients who underwent total joint arthroplasty between 2000 and 2005. PE was diagnosed in 144 patients (1.1%). Shortness of breath (31.9%) and hypotension (30.6%) were the most frequent symptom and sign. Oxygen desaturation was the only indication for investigation of PE in 10% of patients. A pulse-oximetry reading of less than 90% was present in 63% of patients, and 92% of patients presented with an increased alveolar-arterial gradient.

Overall, clinical signs and symptoms as well as severity of hypoxia did not correlate with size and location of PE. Patients with PE demonstrated a significant decrease in arterial oxygen content; an abnormal alveolar-arterial gradient was the most consistent finding in these patients.

Common clinical signs and symptoms, as well as changes in vital signs, have a low sensitivity for diagnosis.