Abstract
BackgroundWhile 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.MethodsThe 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.ResultsOn 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.ConclusionsUtilizing 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.
Highlights
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 had a lower VTED risk compared to primary TKA, an unexpected finding because of its theoretical increased risk
While there have been numerous studies examining the risk of VTED in primary total knee arthroplasty (TKA), far fewer studies have investigated how that risk compares to other knee arthroplasty procedures, such as unicompartmental knee arthroplasty (UKA) and revision TKA [1, 2, 12,13,14,15,16,17]
We hypothesized that UKA would have less risk of VTED and revision TKA would have greater risk of VTED due to their relative differences in surgical complexity compared to primary TKA
Summary
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 had a lower VTED risk compared to primary TKA, an unexpected finding because of its theoretical increased risk. In the most up-to-date iteration of its guidelines, the American Academy of Orthopaedic Surgeons (AAOS) recommended some form of prophylaxis via pharmacologic agents and/or mechanical compressive devices in patients undergoing hip and knee arthroplasty without an elevated bleeding or VTED risk [8]. This recommendation does not discriminate between arthroplasty types, despite differing reported rates and risks of VTED in the literature [9,10,11].
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