Total joint arthroplasty (TJA) is categorized as a major risk factor for thromboembolic complications. The importance of hypoxemia during the postoperative period is subject of controversy. This prospective study elucidates the incidence and etiology of hypoxemia after TJA. Furthermore, we intended to assess the predictive value of clinical findings in identifying the etiology of hypoxemia after TJA. Of 1971 patients, 78 (4.0%) experienced an acute episode of hypoxemia during their hospitalization after TJA. Hypoxemia as the initial presenting sign, predicted major complications, defined as life-threatening if left untreated, in 32% of the hypoxic population. These diagnoses included pulmonary embolism, pulmonary edema, and pneumonia. Tachypnea was the only independent factor associated with pulmonary embolism. Our study presents the incidence and etiology of hypoxemia after TJA, and we recommend a heightened appreciation for the hypoxemic patient.
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