DVT post THR

Question 1

hx

Answer 1

68 yr old M R lower leg pain and swelling over 2 days
3 wks post THR
difficult to move since operation because of poorly controlled pain

Question 2

look

Answer 2

antalgic gait, red and swollen r lower leg, healing THR scar, no obvious redness or discharge from scar

Question 3

feel

Answer 3

tender warm calf

pitting oedema r lower leg

Question 4

active and passive movement knee and ankle

Answer 4

full ROM but pain during movement

Question 5

resisted movement knee and ankle

Answer 5

no pain reproduced

Question 6

other ex`am findings

Answer 6

apyrexial
check mid-calf circumference on both lower limbs
affected side wider if DVT

Question 7

DDx

Answer 7

DVT
cellulitis
ruptured Baker’s cyst
calf strain

Question 8

why is DVT of lower limb likely?

Answer 8

3 wks post THR
acute onset pain and swelling lower leg
red warm tender pitting oedema more swollen than other leg

Question 9

why is cellulitis unlikely?

Answer 9

no local wound/ sign of infection, no fever

need to FBC, ESR, CRP if any doubt

Question 10

why is ruptured Baker’s cyst unlikely?

Answer 10

pain localised to medial/lateral joint line, a/w locking, popliteal mass visible and palpable on knee extension

Question 11

why is calf strain unlikely?

Answer 11

no pain on resisted movement

Question 12

investigations

Answer 12

bloods
Well’s score
Venous duplex U/S gold standrad

Question 13

if DVT is present, bloods will show

Answer 13

FBC normal WCC
CRP raised [could be inflammation]
D-dimers sensitive but not specific

Question 14

Tx when DVT is confirmed

Answer 14

LMWH Enoxaparin 1.5mg/kg/24 hrs subcutaneously once daily
warfarin as per INR for at least 3 months/ 6 months if no cause found or recurrent DVT or thrombophilia
NOACs
IVC FILTERS