Effect of body mass index on symptomatic venous thromboembolism and prosthesis revision risk after total knee arthroplasty: a long-term study from China

Abstract

Objective To investigate the effect of body mass index (BMI) on the risk of symptomatic VTE and prosthesis revision after total knee arthroplasty (TKA). Methods Seven thousand one hundred eighty-two patients with primary unilateral TKA treated in our hospital from 2011 to 2020 were divided into four groups according to BMI: BMI < 25 kg/m2, BMI 25 kg/m2–29.9 kg/m2, BMI 30 kg/m2–34.9 kg/m2 and BMI ≥ 35 kg/m2. Incidence, Odds ratio and Kaplan-Meier survival analysis were used to evaluate the effects of BMI on symptomatic VTE and prosthesis revision risk after TKA. Results The incidence of VTE after TKA was 8.9‰(64/7182). There was no significant difference in the incidence of VTE among different BMI groups(P = 0.452). Deep vein thrombosis mainly occurred in the distal lower extremities, especially in intermuscular veins. Revision rate of prosthesis after TKA was 6.4‰(46/7182). There was no significant difference in revision rate among different BMI groups(P = 0.718). In the univariate analysis of TKA, compared with patients with normal BMI, the risk of postoperative VTE and prosthesis revision in patients with overweight, obesity class I and obesity class II did not increase. Higher prosthesis revision rate and lower prosthesis survival rate were observed in BMI ≥ 35 kg/m2 group, although the difference was not statistically significant. Conclusions Through such a retrospective large sample data of long-term follow-up, we believe that the higher BMI was not associated with the increased risk of symptomatic VTE and prosthesis revision after TKA. When TKA was used for appropriate indications, high BMI should not be considered as a contraindication.

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

“…However, other retrospective data are in conflict with these series. The effect of body mass index on symptomatic VTE after total knee arthroplasty was not observed by Shao et al 39 Thompson et al 40 collected data from 10 217 primary joint arthroplasties and compared patients with BMI <40 kg m −2 with those with a BMI ≥40 kg m −2 . There was no increase in the odds of PE or proximal DVT.…”