Prior Venous Thromboembolism Increases Risk of 90-Day Deep Vein Thrombosis, Pulmonary Embolism, and 2-Year Periprosthetic Joint Infection After Total Knee Arthroplasty.

Abstract

Venous thromboembolism (VTE) is a serious complication following total knee arthroplasty (TKA). While a history of prior VTE is a recognized risk factor for subsequent events, the impact of its timing relative to surgery on postoperative outcomes is unclear. This study examined the association between prior VTE timing and postoperative deep vein thrombosis (DVT), pulmonary embolism (PE), readmission, and periprosthetic joint infection (PJI) following TKA. A retrospective cohort study using a large national database identified patients who underwent primary TKA using Current Procedural Terminology (CPT) codes. Patients who had a prior VTE were stratified by interval from VTE to TKA (zero to three, three to six, six to 12, 12 to 18, 18 to 24 months, then yearly up to five years). Propensity score matching (PSM) (1:1) controlled for demographics and comorbidities, resulting in 22,447 patients who had a prior VTE compared to matched controls. Outcomes included 90-day postoperative DVT, PE, hospital readmissions, and 2-year PJI. Statistical analyses used Chi-square and Welch's t-tests. Patients who had a prior VTE had higher 90-day DVT after TKA (13.2 versus 1.5%; odds ratio (OR) 10.0 [8.9 to 11.2]) and higher 90-day PE (1.8 versus 0.2%; OR 9.2 [6.7 to 12.5]). The odds of developing VTE postoperatively increased as the VTE-to-surgery interval shortened, with the highest rates in patients who had a recent (zero to three months) VTE. Prior VTE was associated with increased 2-year PJI risk (2.4 versus 1.8%; OR [odds ratio] 1.3 [1.2 to 1.5]). Prior VTE significantly increased the risk of 90-day DVT, PE, and 2-year PJI after TKA. Patients who had a recent VTE may warrant enhanced perioperative surveillance, individualized thromboprophylaxis, and heightened infection risk awareness.