Incidence of Deep Vein Thrombosis and Venous Thromboembolism following TKA in Rheumatoid Arthritis versus Osteoarthritis: A Meta-Analysis.

Do-Kyung Lee,Dae-Hee Lee,Hyun-Jung Kim,Rudolf Kirchmair

doi:10.1371/journal.pone.0166844

Do-Kyung Lee, Dae-Hee Lee + Show 2 more

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https://doi.org/10.1371/journal.pone.0166844

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Abstract

This meta-analysis was designed to compare the incidence of deep vein thrombosis (DVT) and venous thromboembolism (VTE) following total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). All studies directly comparing the post-TKA incidence of DVT and/or VTE in patients with RA and OA were included. For all comparisons, odds ratios and 95% confidence intervals (CI) were calculated for binary outcomes. Six studies were included in the meta-analysis. The pooled data showed that the combined rates of asymptomatic and symptomatic DVT did not differ significantly in the RA and OA groups (1065/222,714 [0.5%] vs. 35,983/6,959,157 [0.5%]; OR 0.77, 95% CI: 0.57 to 1.02; P = 0.07). The combined rates of asymptomatic and symptomatic DVT and pulmonary embolism (PE) after TKA were significantly lower in the RA than in the OA group (1831/225,406 [0.8%] vs. 63,953/7,018,721 [0.9%]; OR 0.76, 95% CI: 0.62 to 0.93; P = 0.008). Conclusiviely, the DVT rates after primary TKA were similar in RA and OA patients. In contrast, the incidence of VTE (DVT plus PE) after primary TKA was lower in RA than in OA patients, despite patients with RA being at theoretically higher risk of thrombi due to chronic inflammation.

Highlights

The vast majority of total knee arthroplasties (TKAs) have been performed in patients with advanced knee osteoarthritis (OA).[1,2,3] patients with rheumatoid arthritis (RA) and severe involvement of the knee joint may be candidates for total knee arthroplasty (TKA).[4]
The most important findings of this meta-analysis were that the incidence of deep vein thrombosis (DVT) after primary TKA did not differ between groups of patients with RA and OA, whereas the incidence of Venous thromboembolism (VTE) after primary TKA was lower in the RA than in the OA group
It is unclear if RA is a risk factor for the development of VTE after TKA, the chronic inflammation associated with RA suggests that thrombi may form more readily in these patients than in patients with OA

Summary

Introduction

The vast majority of total knee arthroplasties (TKAs) have been performed in patients with advanced knee osteoarthritis (OA).[1,2,3] patients with rheumatoid arthritis (RA) and severe involvement of the knee joint may be candidates for TKA.[4]. VTE is considered more likely to develop in patients with RA than OA, because chronic inflammatory mediators in RA are associated with prothrombotic factors and endothelial dysfunction, making these patients more. VTE Occurrence after TKA in RA vs OA susceptible to the development of atherosclerosis and thrombosis.[5,6] few studies to date have directly compared the incidence of VTE after TKA in patients with RA and OA, with some comparative studies showing contradictory results [7,8,9]. The relative incidence of VTE after TKA in patients with RA and OA is unclear

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