Is Septic Revision Knee Arthroplasty Associated With Higher Thromboembolic Events? A Matched Cohort Study

There is a paucity of literature assessing the incidence and characteristics of acute and chronic thromboembolic events following septic versus aseptic revision knee arthroplasty. The current study aimed to evaluate these complications between these populations.

This retrospective cohort study used a national database (2010 to 2022) to examine postoperative outcomes in patients who underwent aseptic or septic revision total knee arthroplasty. Outcomes of interest included acute thromboembolic events such as pulmonary embolism (PE), deep vein thrombosis, myocardial infarction, cerebrovascular disease, precerebral occlusion, and chronic thromboembolic events such as chronic thromboembolic pulmonary hypertension, postthrombotic syndrome, limb ischemia, lower-limb amputation, chronic PE, and secondary pulmonary hypertension. A 1:1 matching was used to control for baseline differences, and multivariate logistic regressions were conducted to compare complication rates between the matched groups.

Septic revision arthroplasty cohorts demonstrated increased rates of PE (odds ratio [OR] = 2.65, 2.45; P < 0.001), deep vein thrombosis (OR = 3.83, 3.35; P < 0.001), myocardial infarction (OR = 3.49, 3.33; P < 0.001), cerebrovascular disease (OR = 3.39, 2.62; P < 0.001), and precerebral occlusion (OR = 3.21, 2.22; P < 0.001) at 30- and 90-day time points, respectively. The same cohort showed increased rates of limb ischemia (OR = 3.11, P < 0.001), lower-limb amputation (OR = 5.99, P < 0.001), chronic PE (OR = 1.65, P < 0.001), and secondary pulmonary hypertension (OR = 2.01, P < 0.001) at two years compared to aseptic revision cohorts. There was no significant difference observed regarding chronic thromboembolic pulmonary hypertension and postthrombotic syndrome.

Septic revision arthroplasty is associated with increased rates of chronic and acute thromboembolic events. Further studies should be performed to evaluate possible underlying mechanisms of these findings.