Disclosures: Bass reports she received grants from Stavros Niarchos Complex Joint Reconstruction Center at Hospital for Special Surgery during the conduct of the study.
April 14, 2021
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Revision TKR for infection, fracture doubles risk for venous thromboembolism

Disclosures: Bass reports she received grants from Stavros Niarchos Complex Joint Reconstruction Center at Hospital for Special Surgery during the conduct of the study.
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Compared with aseptic revision total knee replacement, revision for periprosthetic joint infection or fracture doubles the risk for postoperative venous thromboembolism, according to the published results.

To study the relationship between infection and risk of VTE, Anne R. Bass, MD, and colleagues at Hospital for Special Surgery analyzed 25,441 New York residents (mean age of 66 years) who underwent revision TKR from 1998 to 2014.

Bass graphic
Adjusted odds ratios for VTE relative to aseptic revision was 2.01 for septic revision TKR and 2.62 for fracture. Data were derived from Bass AR, et al. J Bone Joint Surg. 2021;doi:10.2106/JBJS.20.01486.

According to the study, the most common indication for revision TKR was aseptic for 69% of patients (n = 17,563). The remaining 28% and 3% of patients were indicated for revision TKR due to infection (n = 7,075) and fracture (n = 803), respectively.

Overall, 2.8% of patients (n = 719) had VTE within 90 days following surgery, with 1.5% of patients (n = 387) experiencing VTE during admission for the revision procedure.

Researchers found the 90-day incidence of VTE was 2.1% after aseptic revision, was 4.3% after revision for infection and was 5.9% after revision for fracture, according to the study. They determined the adjusted odds ratio for VTE relative to aseptic revision was 2.01 for septic revision TKR and 2.62 for fracture. Researchers also noted a history of VTE was a “strong risk factor” for VTE following revision TKR.

“We found that the odds of VTE after revision total knee replacement for infection were double those after aseptic revision total knee replacement,” Bass and colleagues wrote in the study. “Although fracture accounts for a small percentage of revision total knee replacements, the risk of VTE was 2.6-fold higher after these procedures. The indication for revision total knee replacement should be considered when choosing postoperative VTE prophylaxis,” they added.