Background/Purpose: Total knee arthroplasty (TKA) reliably relieves pain and improves function in patients with end-stage arthropathy of the knee such as rheumatoid arthritis (RA). The most common complication after knee arthroplasty is DVT. The significance of DVT lies in the possibility of PE and the occurrence of chronic venous insufficiency at a later stage. PE is a potentially life-threatening disorder and is among the most common causes of death postoperatively. Previous studies have reported elevated risks of DVT in patients with RA. If a high risk of DVT is identified in the patient’s background and medical history, it might be useful in early diagnosis. It is not reported whether the prevalence of DVT in the RA patients undergoing TKA is higher compared with non-RA patients or not. Thus, we investigated the patient’s background and medical history in patients admitted to hospital for TKA and identified the risk factors, including RA, for DVT development before TKA.

Methods:

Patients

From 2003 to 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.

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%). The second most frequent preoperative medical history or medical condition was major surgery (50.5%), 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 (p = 0.039), who had RA (p=0.006), and who were admitted for revision TKA (p=0.033) using Fisher’s exact test. Multiple linear regression analysis was performed to test the association of DVT with putative risk factors. The analysis showed that admission for RA (p=0.049) and revision TKA (p=0.009) were significant independent risk factors for preoperative DVT.

Conclusion: RA and admission for revision TKA surgery were risk factors for DVT among those admitted to the hospital for TKA. The results also suggest that instrumental screening should be encouraged, at least in subgroups at higher risk for preoperative DVT.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-risk-factor-of-preoperative-deep-vein-thrombosis-in-patients-undergoing-total-knee-arthroplasty/