The Safety of Patients Who Have Preoperative Venous Thromboembolism Undergoing Joint Arthroplasty

Some patients requiring joint arthroplasty are predisposed to preoperative venous thromboembolism (VTE). However, the impact of preoperative VTE has been infrequently reported. The objective was to investigate the risk factors and postoperative changes of preoperative VTE and assess joint arthroplasty safety.

This study included patients who underwent hip and knee arthroplasty between 2015 and 2022. The incidence and risk factors of preoperative VTE were analyzed, and management strategies for different patient groups were summarized. All patients underwent dynamic lower-limb vascular Doppler ultrasound examinations preoperatively, postoperatively, and during follow-up. Postoperative complications in patients who had preoperative VTE were documented, and factors influencing changes in preoperative VTE were systematically analyzed. The analysis included 7,878 patients, who had an average age of 65 years (range, 18 to 99). A total of 590 patients (7.5%) presented with preoperative VTE, including 423 hip arthroplasty and 167 knee arthroplasty cases. Among these, three cases (0.5%) had pulmonary embolism, 39 (6.6%) had proximal deep vein thrombosis (DVT), and 548 (92.9%) had distal DVT.

Postoperatively, 85 patients experienced VTE progression, 379 had no change, and 106 showed improvement. There were no significant differences in mortality or pulmonary embolism rates between the preoperative VTE group and the non-VTE group (P > 0.05). Risk factors for the progression of preoperative VTE after surgery included unilateral DVT, postoperative D-dimer levels greater than five mg/L, and bed rest exceeding one day (P < 0.05). Conversely, hip fracture was associated with improved postoperative VTE outcomes, while prolonged bed rest was a hindering factor (P < 0.05). At the 3-month follow-up, 131 patients were found to have DVT. Within one year postoperatively, no patients developed symptomatic VTE, and 10 patients died from non-thrombus-related causes.

This study demonstrated that joint arthroplasty was safe for patients who had preoperative VTE. In addition, early ambulation after surgery aided thrombus improvement.