An analysis of risk factors for venous thromboembolism in primary versus revision total joint arthroplasty

Jackson P Tate; James H Padley; Swarnali Banerjee; Andrew M Schneider; Nicholas M Brown

doi:10.1016/j.jcot.2023.102296

An analysis of risk factors for venous thromboembolism in primary versus revision total joint arthroplasty

J Clin Orthop Trauma. 2023 Nov 29:46:102296. doi: 10.1016/j.jcot.2023.102296. eCollection 2023 Nov.

Authors

Jackson P Tate¹, James H Padley¹, Swarnali Banerjee², Andrew M Schneider³, Nicholas M Brown⁴

Affiliations

¹ Loyola University Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL, 60153, USA.
² Loyola University Chicago Department of Mathematics and Statistics, Loyola Hall, 1110 W. Loyola Ave, Chicago, IL, 60660, USA.
³ University of Chicago Deparstment of Orthopaedic Surgery and Rehabilitation Services, 5758 S. Maryland Avenue, Chicago, IL, 60637, USA.
⁴ Loyola University Medical Center Department of Orthopaedic Surgery, 2160 S 1st Ave, Maywood, IL, 60153, USA.

PMID: 38145162
PMCID: PMC10746504 (available on 2024-11-29)
DOI: 10.1016/j.jcot.2023.102296

Abstract

Background: One of the most serious complications after primary or revision lower extremity total joint arthroplasty (TJA) is venous thromboembolism disease (VTE). Identifying patients at high risk for VTE allows tailoring of prophylactic anticoagulation regimens to those most vulnerable. This study aimed to identify risk factors for VTE in primary and revision lower extremity TJA.

Methods: The Electronic Medical Record was queried from a single academic institution for all patients who underwent a lower extremity TJA between 2007 and 2020. Demographics, comorbid conditions, perioperative characteristics, and postoperative complications were identified. An Elastic Net Multiple Logistic Regression Model was used to assess 49 covariates and predict those associated with a significant risk of VTE.

Results: We identified 4900 primary and revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. There was no significant difference between primary and revision THA. Primary TKA had a higher rate of VTE than revision TKA. Significant risk factors identified for VTE in THA patients include histories of deep vein thrombosis (DVT), pulmonary embolism (PE), metastatic tumors, hemiplegia, and Hispanic ethnicity. Risk factors for VTE in TKA patients include histories of DVT, PE, metastatic tumors, and postoperative warfarin and heparin use. In all patients, age was a significant predictor of VTE risk.

Conclusion: Our work identifies many risk factors for VTE following TJA. While the increased rate of VTE in some populations may represent selection bias, it also highlights the incomplete understanding of the etiology and prevention of this complication in the joint arthroplasty population and requires further study.

Keywords: DVT; Hip; Knee; PE; Revision; Thromboembolism.