Fatal pulmonary embolism (PE) after total hip replacement (THR) is a major concern to all orthopaedic surgeons. Our intention was to ascertain death rates and deaths due to PE following total hip replacement where chemical thromboprophylaxis was not used routinely.

We determined retrospectively, the postoperative mortality and fatal pulmonary embolism rates in 1671 consecutive primary total hop replacements in 1547 patients performed as staged procedures between January 1997 and April 2000 at an orthopaedic hospital. The minimum follow-up period was six weeks period after surgery at an orthopaedic hospital. Patients were traced by questionnaires, outpatient appointments and by telephone. Post-mortem records were used to verify cause of death. Follow-up was 100%. The death rate from PE was 0. 12% (CI 0. 03% – 0. 44%) and the all-cause mortality rate was 0. 36% (CI 0. 16% – 0. 78%). All deaths were within the first 10 days during the initial hospital stay. The patient mortality was compared with the population mortality for England and Wales, using standardised mortality ratios (SMRs). The SMR for both sexes combined was 0. 81. We observed a lower mortality in females (SMR=0. 43) but a higher mortality in males (SMR=1. 44) during the first 42 postoperative days compared to the general population.

Fatal PE after THR without routine chemical thromboprophylaxis is very uncommon. The death rate in patients undergoing THR appears to be lower than that in the general population.

Venous ulceration is a chronic disabling complication of deep vein thrombosis. The aim of this study is to estimate the incidence of venous leg ulcers five years or more after total hip replacement, and to investigate some of the clinical features associated with the development of the ulcers. A postal survey of all the patients who had received a total hip replacement 5–12 years previously was done.

Replies from 816 patients yielded 66 patients [8.1.%] with a history of leg ulcers. Prevalence of active ulceration was 2.6%. 43 patients [5.3%] reported ulceration since their hip replacement. A clinical review determined that 31 [3.8%] of these were true venous ulcers. The ulcers occurred with a higher frequency on the operated side, appearing at a mean of 5.8 years after the first lower limb arthroplasty [range 18 months to 12 years]. An average of 1.9 arthroplasties [primary and revision] were carried out prior to the ulcers appearing [max 5, min 1]. Our findings suggest that although the overall incidence rate of leg ulcers was similar to that reported in the general population, we found a tendency for the ulcers to occur on the operated rather than the unoperated leg.