Background Venous thromboembolism (VTE) is a common complication during and after a hospital admission. That is associated with significant morbility and mortality after orthopedic surgery. To avoid the development of VTE after orthopedic surgery, it is essential to reduce the onset of deep vein thrombosis (DVT) and to diagnose DVT early. The clinical signs and symptoms of DVT are unreliable. It leads to early diagnosis to find a risk factor of DVT from medical history of the patient. However, the risk for preoperative DVT in patients for knee joint orthopedic surgery remains unclear. We, therefore, decided to study the risk of DVT in patients admitted to hospital for total knee arthroplasty (TKA).
Objectives The purpose of this study was to identify the risk factors for DVT development before TKA.
Methods Patients. From September of 2003 to December of 2013, 319 patients admitted for TKA at Mie University Hospital were eligible for the present retrospective study. The surgical diagnoses were degenerative osteoarthritis (OA) in 274 patients and rheumatoid arthritis (RA) in 45 patients. The patients' sex, weight, body mass index (BMI, weight in kilograms divided by the square of the height in meters), and data from the medical history and medical condition were recorded.
Diagnosis of DVT. B-mode ultrasonography with compression and color Doppler imaging were performed for bilateral common femoral veins, the superficial veins, the popliteal veins, and the calf veins.
Statistical analysis. The patients' preoperative characteristics were compared between the DVT-positive and DVT-negative patients using the Mann-Whitney U test and Fisher's exact test. Multiple linear regression analysis was performed to identify independent risk factors for preoperative DVT. P values <0.05 were considered statistically significant.
Results The preoperative diagnosis was OA in 274 patients (85.9%) and RA in 45 patients. Moreover, admissions for joint replacement in this population were for primary procedures in 300 patients (94.0%) and revision TKA in 19 patients. The most frequent preoperative medical history or medical condition was hypertension (52.7%; 168 patients). The second most frequent preoperative medical history or medical condition was major surgery (50.5%; 161 patients), including a history of primary TKA and cancer surgery
Preoperative DVT was diagnosed in 57 of 319 (17.9%) patients overall. Significantly elevated risks of DVT were found in patients who were female, who had RA, and who were admitted for revision TKA. Overall, 91.2% (52/57 patients) of the DVT-positive group were female, but only 79.0% (207/262) of the DVT-negative group were female (p=0.039). RA was seen in 26.3% (15/57; p=0.006) of the DVT- positive group and 11.5% (30/262) of the DVT-negative group. The incidence of DVT was significantly higher in patients admitted for revision TKA (9 of 19 patients; 47.4%) than in patients for admitted for primary procedures (48 of 300 patients; 16.0%). The incidence of preoperative DVT was significantly greater in RA patients than in OA patients among those undergoing revision TKA (p=0.033).
Conclusions RA and admission for revision TKA surgery were risk factors for DVT among those admitted to the hospital for TKA.
Disclosure of Interest None declared
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