Skip to main content


Log in

Duplex Ultrasonography Has Limited Utility in Detection of Postoperative DVT After Primary Total Joint Arthroplasty

  • Original Article
  • Published:
HSS Journal ®



Duplex ultrasound is routinely used to evaluate suspected deep venous thrombosis after total joint arthroplasty. When there is a clinical suspicion for a pulmonary embolism, a chest angiogram (chest CTA) is concomitantly obtained.


Two questions were addressed: First, for the population of patients who receive duplex ultrasound after total joint arthroplasty, what is the rate of positive results? Second, for these patients, how many of these also undergo chest CTA for clinical suspicion of pulmonary embolus and how many of these tests are positive? Furthermore, what is the correlation between duplex ultrasound results and chest CTA results?


A retrospective chart review was conducted of total joint replacement patients in 2011 at a single institution. Inclusion criteria were adult patients who underwent a postoperative duplex ultrasonography for clinical suspicion of deep venous thrombosis (DVT). Demographic data, result of duplex scan, clinical indications for obtaining the duplex scan, and DVT prophylaxis used were recorded. Additionally, if a chest CTA was obtained for clinical suspicion for pulmonary embolus, results and clinical indication for obtaining the test were recorded. The rate of positive results for duplex ultrasonography and chest CTA was computed and correlated based on clinical indications.


Two hundred ninety-five patients underwent duplex ultrasonography of which only 0.7% were positive for a DVT. One hundred three patients underwent a chest CTA for clinical suspicion of a pulmonary embolism (PE) of which 26 revealed a pulmonary embolus, none of which had a positive duplex ultrasound.


Postoperative duplex scans have a low rate of positive results. A substantial number of patients with negative duplex results subsequently underwent chest CTA for clinical suspicion for which a pulmonary embolus was found, presumably resulting from a DVT despite negative duplex ultrasound result. A negative duplex ultrasonography should not rule out the presence of a DVT which can embolize to the lungs and thus should not preclude further workup when clinical suspicion exists for a pulmonary embolus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Anderson DR, Gross M, Robinson KS, Petrie D, Leighton R, Stanish W, et al. Ultrasonographic screening for deep vein thrombosis following arthroplasty fails to reduce posthospital thromboembolic complications: The postarthroplasty screening study (PASS). Chest 1998;114.

  2. Bendayan P, Boccalon H. Cost effectiveness of non-invasive tests including duplex scanning for diagnosis of deep venous thrombosis. A prospective study carried out on 511 patients. Vasa. 1991; 20(4): 348-53.

    CAS  PubMed  Google Scholar 

  3. Borris LC, Lassen MR. Thromboprophylaxis with low molecular weight heparin after major orthopaedic surgery is cost effective. Drugs. 1996; 52(Suppl 7): 42-6.

    Article  PubMed  Google Scholar 

  4. Bradley MJ et al. Colour flow mapping in the diagnosis of the calf deep vein thrombosis. Clin Radiol. 1993; 47(6): 399-402.

    Article  CAS  PubMed  Google Scholar 

  5. Ciccone WJ 2nd, Reid JS, Pellegrini VD Jr. The role of ultrasonography in thromboembolic disease management in the orthopaedic patient. Iowa Orthop J. 1999; 19: 18-25.

    PubMed  PubMed Central  Google Scholar 

  6. Della Valle CJ, Steiger DJ, DiCesare PE. Duplex ultrasonography in patients suspected of postoperative pulmonary embolism following total joint arthroplasty. Am J Orthop (Belle Mead NJ). 2003; 32: 386-8.

    Google Scholar 

  7. Fowl RJ et al. Inappropriate use of venous duplex scans: an analysis of indications and results. J Vasc Surg. 1996; 23(5): 881-5. discussion 885–6.

    Article  CAS  PubMed  Google Scholar 

  8. Goodacre S et al. Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess. 2006; 10(15): 1-168. iii-iv.

    Article  CAS  PubMed  Google Scholar 

  9. Grady-Benson JC et al. Postoperative surveillance for deep venous thrombosis with duplex ultrasonography after total knee arthroplasty. J Bone Joint Surg Am. 1994; 76(11): 1649-57.

    CAS  PubMed  Google Scholar 

  10. Hull R et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993; 329(19): 1370-6.

    Article  CAS  PubMed  Google Scholar 

  11. Iorio R et al. Routine duplex ultrasound screening after TKA is not necessary. Clin Orthop Relat Res. 2006; 452: 171-4.

    Article  PubMed  Google Scholar 

  12. Jimenez D et al. Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med. 2010; 181(9): 983-91.

    Article  PubMed  Google Scholar 

  13. Kakkar VV. Cost-effectiveness of the low molecular weight heparin reviparin sodium in thromboprophylaxis. Thromb Res. 1996; 81(2 Suppl): S75-7.

    Article  CAS  PubMed  Google Scholar 

  14. Mattos MA et al. Color-flow duplex scanning for the surveillance and diagnosis of acute deep venous thrombosis. J Vasc Surg. 1992; 15(2): 366-75. discussion 375–6.

    Article  CAS  PubMed  Google Scholar 

  15. McCoy KL, Gahtan V, Kerstein MD. Use of venous duplex scans to evaluate symptoms of deep vein thrombosis: An analysis of ultrasound usage by various medical specialties. Am Surg. 1999; 65(5): 417-20.

    CAS  PubMed  Google Scholar 

  16. Mc LJ, Paterson JC. Some basic observations on venous thrombosis and pulmonary embolism. Surg Gynecol Obstet. 1951; 93(1): 1-8.

    Google Scholar 

  17. Robinson KS, Anderson DR, Gross M, et al. Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: The post-arthroplasty screening study. A randomized, controlled trial. Ann Intern Med. 1997; 127: 439-45. doi:10.7326/0003-4819-127-6-199709150-00004.

    Article  CAS  PubMed  Google Scholar 

  18. Rose SC et al. Symptomatic lower extremity deep venous thrombosis: Accuracy, limitations, and role of color duplex flow imaging in diagnosis. Radiology. 1990; 175(3): 639-44.

    Article  CAS  PubMed  Google Scholar 

  19. Schwarcz TH et al. Surveillance venous duplex is not clinically useful after total joint arthroplasty when effective deep venous thrombosis prophylaxis is used. Ann Vasc Surg. 2004; 18(2): 193-8.

    Article  PubMed  Google Scholar 

  20. Schwarcz TH et al. Enoxaparin treatment in high-risk trauma patients limits the utility of surveillance venous duplex scanning. J Vasc Surg. 2001; 34(3): 447-52.

    Article  CAS  PubMed  Google Scholar 

  21. Unay K et al. Evaluating the effectiveness of a deep-vein thrombosis prophylaxis protocol in orthopaedics and traumatology. J Eval Clin Pract. 2009; 15(4): 668-74.

    Article  PubMed  Google Scholar 

  22. Zierler BK. Ultrasonography and diagnosis of venous thromboembolism. Circulation. 2004; 109(12 Suppl 1): I9-14.

    Article  PubMed  Google Scholar 

Download references


We would like to thank Leon Rybak, MD, for providing the ultrasound images for this study. We sadly report the passing of Frederick Jaffe, MD, senior author on this manuscript. This is his final contribution to the orthopedic field and marks the culmination of a distinguished career as an orthopedic surgeon as well as a mentor and a role model to the junior authors of this study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Shaleen Vira MD.

Ethics declarations

Conflict of Interest:

Shaleen Vira, MD; Austin J. Ramme, MD, PhD; Michael J. Alaia, MD; David Steiger, MD; Jonathan M. Vigdorchik, MD; and Frederick Jaffe, MD, have declared that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was waived from all patients for being included in the study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Diagnostic Study Level III.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.


(PDF 1226 kb)


(PDF 1226 kb)


(PDF 1226 kb)


(PDF 1226 kb)


(PDF 1226 kb)


(PDF 1226 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vira, S., Ramme, A.J., Alaia, M.J. et al. Duplex Ultrasonography Has Limited Utility in Detection of Postoperative DVT After Primary Total Joint Arthroplasty. HSS Jrnl 12, 132–136 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: