Abstract
Background: Hip and knee replacement surgeries have been linked to a transient increase in venous thromboembolism (VTE) risk in the short term. However, there is limited evidence regarding the extended impact of these surgeries on VTE risk beyond the first year. Objective: This prospective matched cohort study aimed to investigate the associations between hip or knee replacement surgery and VTE risk over a 10-year period, examining how these associations evolved over time. Methods: Analyzing data from 496,862 adults recruited between 2006 and 2010 in the UK Biobank study, 21,155 hip replacement surgery patients and 21,899 knee replacement surgery patients were identified and matched with the general population using exposure density sampling. The piecewise Cox proportional hazards model was employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for VTE outcomes at different intervals within the 10 years post-surgery. Results: For the hip replacement surgery cohort (n=221,138), the mean age was 61.5 (standard deviation [SD] 6.8), 40.7% were men, and 407 (1.9%) patients with hip surgery developed VTE during follow-up. In the knee replacement surgery cohort (n=199,487), the mean age was 61.7 (SD 6.4), 44.5% were men, and 436 (2.5%) patients with knee surgery developed VTE. Adjusting for various factors, the elevated risk peaked within 30 days post-surgery, with HRs (95% CIs) of 21.4 (15.4-29.6) and 33.0 (23.4-46.4) for hip and knee replacement, respectively. The elevated risk persisted until the tenth year, with HRs (95% CIs) of 1.59 (1.23-2.04) and 1.68 (1.21-2.33) for hip and knee replacement, respectively. These associations were held across participant characteristics and in sensitivity analysis. Conclusions: In middle-aged and older British adults, hip or knee replacement surgery was associated with both short- and long-term VTE risk, with the heightened risk persisting for up to a decade.
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