Venous Thromboembolism in Total Knee Arthroplasty

Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. Methods A study of 2,393 TKAs was performed in 2,393 patients. Patient demographics, comorbidities, OKS, EuroQol five-dimension score (EQ-5D), and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and compared with those without. Results A total of 37 patients (1.5%) suffered a VTE and were significantly more likely to have associated comorbidities of stroke (p = 0.026), vascular disease (p = 0.026), and kidney disease (p = 0.026), but less likely to have diabetes (p = 0.046). In an unadjusted analysis, patients suffering a VTE had a significantly worse postoperative OKS (difference in mean (DIM) 4.8 (95% confidence interval (CI) 1.6 to 8.0); p = 0.004) and EQ-5D (DIM 0.146 (95% CI 0.059 to 0.233); p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent predictor associated with a worse postoperative OKS (DIM -5.4 (95% CI -8.4 to -2.4); p < 0.001), and EQ-5D score (DIM-0.169 (95% CI -0.251 to -0.087); p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89 (95% CI 0.35 to 2.07); p = 0.717). Conclusion Patients who had a VTE within six months of their TKA had clinically significantly worse knee-specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):1254–1260.

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Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty

Medicine ◽

10.1097/md.0000000000013465 ◽

2018 ◽

Vol 97 (48) ◽

pp. e13465 ◽

Cited By ~ 3

Author(s):

Hai-Feng Huang ◽

Shan-Shan Li ◽

Xian-Teng Yang ◽

Quan Xie ◽

Xiao-Bin Tian

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Total Knee

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Clinical benefit of graduated compression stockings for prevention of venous thromboembolism after total knee arthroplasty: post hoc analysis of a phase 3 clinical study of edoxaban

Thrombosis Journal ◽

10.1186/s12959-016-0087-z ◽

2016 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Takeshi Fuji ◽

Satoru Fujita ◽

Tetsuya Kimura ◽

Kei Ibusuki ◽

Kenji Abe ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Clinical Study ◽

Knee Arthroplasty ◽

Clinical Benefit ◽

Compression Stockings ◽

Phase 3 ◽

Post Hoc Analysis ◽

Total Knee ◽

Post Hoc

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Different Doses of Intravenous Tranexamic Acid in Revision Total Knee Arthroplasty: A Retrospective Study

The Journal of Knee Surgery ◽

10.1055/s-0041-1740585 ◽

2021 ◽

Author(s):

Liyile Chen ◽

Chenchen Zhao ◽

Yue Luo ◽

Qiuru Wang ◽

Qianhao Li ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Length Of Stay ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Total Knee ◽

Revision Tka ◽

Different Doses

Abstract Purpose This article assessed the efficacy and safety of different doses of intravenous tranexamic acid (TXA) in revision total knee arthroplasty (TKA). Methods We retrospectively identified 122 patients in our institution who underwent revision TKA with a history of perioperative intravenous TXA utilization. According to the sum of intravenous TXA documented, all patients were divided into three groups: 1 g intravenous TXA, 2 g intravenous TXA, and equal or greater than 3 g intravenous TXA. The primary outcomes included total blood loss (TBL), hidden blood loss (HBL), transfusion rate, and the incidence of symptomatic venous thromboembolism among the three groups. A correlation analysis was conducted to analyze the correlation between the dose of TXA and the blood loss. Results In total, there was no significance difference in TBL and revised HBL (rHBL) between the first two groups (1 g/dL for intravenous TXA, 2 g/dL for intravenous TXA; p = 0.486; p = 0.525). Equal or greater than 3 g intravenous TXA (≥3 g/dL for intravenous TXA) reached a significant reduction in TBL, rHBL, and length of stay compared with the first two groups (p = 0.01; p = 0.01; p = 0.01). The rate of transfusion between the three groups did not differ significantly (p = 0.21). Due to the limitations in sample size, only one symptomatic venous thromboembolism was reported in the 1 g intravenous TXA group. Conclusion Applying the dose of intravenous TXA equal or greater than 3 g in revision TKA might further reduce the blood loss and shorten the length of stay.

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Oral Direct Thrombin Inhibitor Ximelagatran Compared with Warfarin for the Prevention of Venous Thromboembolism After Total Knee Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200605000-00039 ◽

2006 ◽

Vol 88 (5) ◽

pp. 1163

Author(s):

Paul A. Lotke ◽

John J. Callaghan ◽

Lawrence D. Dorr ◽

Gerard H. Engh ◽

Arlen D. Hanssen ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Direct Thrombin Inhibitor ◽

Thrombin Inhibitor ◽

Oral Direct Thrombin Inhibitor ◽

Total Knee

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The Effect of Bladder Catheterization on Ambulation and Venous Thromboembolism Following Total Knee Arthroplasty: An Institutional Analysis

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.02.045 ◽

2020 ◽

Vol 35 (6) ◽

pp. S197-S200 ◽

Cited By ~ 1

Author(s):

Peter A. Gold ◽

Luke J. Garbarino ◽

Hiba K. Anis ◽

Jamie C. Heimroth ◽

Nipun Sodhi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Institutional Analysis ◽

Bladder Catheterization ◽

Total Knee

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Unicompartmental knee arthroplasty and revision total knee arthroplasty have a lower risk of venous thromboembolism disease at 30 days than primary total knee arthroplasty

Knee Surgery and Related Research ◽

10.1186/s43019-020-00078-9 ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Andrew M. Schneider ◽

Daniel R. Schmitt ◽

Nicholas M. Brown

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Lower Risk ◽

Primary Total Knee Arthroplasty ◽

Unicompartmental Knee ◽

Total Knee ◽

Revision Tka ◽

Primary Total Knee

Abstract Background While multiple studies have demonstrated a lower venous thromboembolism disease (VTED) risk for unicompartmental knee arthroplasty (UKA) compared to primary total knee arthroplasty (TKA), recent reports have shown that revision TKA also had a lower VTED risk compared to primary TKA, an unexpected finding because of its theoretical increased risk. Given the paucity of up-to-date comparative studies, our goal was to perform a high-powered VTED risk comparison study of UKA and revision TKA to primary TKA using recent data. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried between 2011 and 2018, and we identified 213,234 patients for inclusion: 191,810 primary TKA, 9294 UKA, and 12,130 revision TKA. Demographics, medical comorbidities, and possible VTE risk factors were collected. Thirty-day outcomes, including deep vein thrombosis (DVT), pulmonary embolism (PE), and all-cause VTED were compared between knee arthroplasty types. Results On multivariate analysis, UKA was significantly associated with lower rates of DVT [OR 0.44 (0.31–0.61); P < 0.001], PE [OR 0.42 (0.28–0.65); P < 0.001], and all-cause VTED [OR 0.42 (0.32–0.55); P < 0.001] when compared to primary TKA. Revision TKA was significantly associated with lower rates of PE [OR 0.62 (0.47–0.83); P = 0.002], and all-cause VTED [OR 0.82 (0.70–0.98); P = 0.029] when compared to primary TKA. Conclusions Utilizing recent data from a nationwide patient cohort and controlling for confounding variables, our results showed that both revision TKA and UKA had a lower risk of VTED compared to primary TKA, corroborating the results of recent investigations. Additional prospective investigations are needed to explain this unexpected result.

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