The article on ultrasonographic screening for deep venous thrombosis after arthroplasty [1] agrees completely with my experience regarding the lack of value of such screening in these patients. In a 6-month period (January through June 1995) at William Beaumont Hospital, ultrasonography was done on patients who had had arthroplasty for whom there was a definite clinical suspicion of deep venous thrombosis. Only 8% of patients had acute femoropopliteal deep venous thrombosis.

Of additional interest in Robinson and colleagues' study [1] was the length of stay, approximately 10 ± 5 days. This length of stay helped to ensure that 85% of the patients were discharged "fully mobile" (and were receiving therapeutic anticoagulation with warfarin on the day of discharge, as much as 2 weeks after surgery); this therapy should also prevent subsequent deep venous thrombosis.

Considering the current practice of discharging patients who have had arthroplasty 4 to 5 days after this surgery, this article supports not only avoiding screening tests for deep venous thrombosis but also continuing warfarin or other prophylactic regimens at home. The literature supports the use of postoperative prophylaxis of deep venous thrombosis for 2 to 4 weeks.

Compared with the cost of arthroplasty and the potential risks and costs of deep venous thrombosis and pulmonary embolism, 2 to 3 weeks of warfarin prophylaxis and monitoring of the prothrombin time at home seem medically and financially beneficial.