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

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.

Comparison of Early Complication Rates After High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Knee Osteoarthritis

“…Ogonda et al 22 analyzed data from the National Joint Registry for England and Wales and found a 1.2% PE rate after UKA, while the Humana database has demonstrated a PE rate of 0.8% after UKA. 2,22 Schneider et al 30 assessed that same database as the present study, without applying an age limit in the UKA group, and found a lower PE rate (0.2%) after UKA. The results of the current study align with the findings by Schneider et al and suggest that even though PE is an infrequent complication, prophylaxis should be considered to avoid devastating consequences.…”

Epidemiology and prognostic factors for new-onset deep venous thrombosis after unicompartmental knee arthroplasty: a retrospective study

“…By contrast, the rate of DVT in patients underwent osteotomies around the knee was exceedingly high, postoperative DVT was detected in 11.9% knees after open wedge high tibial osteotomy and 22.6% in later closed wedge high tibial osteotomy respectively [ 6 ]. As for VTEs after joint arthroplasty surgery, incidence of DVT ranges from 0.4 to 42% [ 7 , 8 ], occurrence of DVT of lower extremity following knee arthroplasty, especially the UKA surgery, is lower than that of hip arthroplasty. In our clinical practice, patients were encouraged to perform ankle pump exercise on the day after operation, meanwhile, pneumatic therapy was also introduced to promote lower limb blood circulation.…”

A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea

“…We found no significant difference between the two surgeries in most complication rates, meanwhile, significant differences were found in the incidence of DVT and surgical site infection. The HTO group showed significantly low infection rate, which may be related to a relatively short operation time [ 22 – 24 ] and showed low risk of DVT possibly due to routine usage of mechanical compression after surgery [ 25 ], and pharmacologic prophylaxis [ 26 ]. There have been previous studies on factors related to ARF after orthopedic surgery, but studies related to different surgical methods, especially artificial joint surgery, have been insufficient and may require further evaluation [ 27 , 28 ].…”