Pulmonary Embolism Rare But Fatal After Total Elbow Replacement

One well-known complication from surgery is a pulmonary embolism, a clot that travels in the bloodstream until it reaches the lungs. This complication does happen between 1.79 percent and 2.27 percent of the time after hip or knee replacement surgery, but until now, there have been no statistics for elbow replacement surgeries. The authors of this study wanted to determine the prevalence of pulmonary embolism after elbow replacements.

Researchers found the records of 1,076 patients with total elbow replacements, 816 with a first-time replacement (primary replacement) and 260 with revisions. All patients had received standard prophylactic, or preventive, anti-blood clotting medication and all used compression devises to minimize clot risk, after surgery. Walking after surgery was also encouraged.

The researchers found that among the replacements, there was a 0.25 percent incidence of pulmonary embolism among patients with primary replacements and a 0.1 percent among patients with revisions. None of the patients had a history of blood clots in the veins. Diagnosis was made between the day of surgery and day 3 after.

The patients were 43-year-old (woman), 39 years (woman), and 57 years (man). The 43-year-old had a primary replacement because of juvenile rheumatoid arthritis. After developing shortness of breath on the day after surgery, she went into respiratory arrest and died. The 39-year-old had a primary replacement because of rheumatoid arthritis. She recovered from the embolism and was able to stop blood thinning medication after 6 months. The man had a revision and also recovered from the embolism, stopping the blood thinners after 3 months.

The authors say that although there has been a lot of research on pulmonary embolism and knee and hip replacement, up to now, there has been nothing on elbow replacement. They were concerned about this because their findings showed that pulmonary embolisms do occur in patients who have upper body surgeries.

They conclude that this is a rare but fatal complication and that this should be kept in mind by surgeons if their patients complain of shortness of breath following surgery of the upper body.

References: Scott F.M. Duncan, et al. Prevalence of Pulmonary Embolism After Total Elbow Arthroplasty. In The Journal of Bone & Surgery. July 2007. Vol. 89. No. 7. Pp. 1452-1453.