Background/Purpose: Joint replacement (JR) surgery is one of the preferred management for end-stage arthritis. Venous Thromboembolism (VTE) is one of the major post-surgical complications after JR. However, trends of the VTE after JR in the UK and whether the guideline updates resulted in a shift in VTE rates has not been studied yet. The aim of the study was to explore if and how rates of VTE after JR have changed in the UK over the last 12 years since the year 2007.

Methods: We used routinely collected primary care data Clinical Practice Research Datalink (CPRD AURUM) and linked hospital episode statistics (HES) and Office of National Statistics (ONS) for the study(1). We included all adult patients who had primary knee, hip or shoulder replacement surgery between October 2007 and September 2019. The outcome for the study was the recording of VTE within 6 months of JR date (index date). The outcome was reported as overall and separately for hip, knee, and shoulder joints. VTE rate estimated during the study period was compared with respect to different intervention introduced by National Health Services (NHS) in the year 2010(2), 2012(3), and 2018(4). Trends of the VTE rates for all the joints and examined using the Cox-Stuart trend test, and the seasonality and impact of the interventions (NHS guidelines) was examined using logistic regression with a polynomial function.

Results: A total of 476,620 joint replacement records were found to be eligible for the study during the study period 1st Oct 2007 and 30th Sep 2019 (both dates inclusive). Nearly 1.5% of total population had recording of VTE within 6 months from the date of the procedure. The prevalence was higher for knee joints (1.6%) followed by hip (1.4%) and shoulder (1%). The incidence rate of VTE after 6 months was 16.85 per 1000 person-6months for knee, 14.81 per 1000 person-6months, and 10.35 per 1000 person-6months. A decline in overall VTE incidence rate was seen until end of the year 2016, followed by a rise in the trend (p trend = 0.02). A significant decline in VTE was reported within 6 months for hip (p = 0.04) and knee joints (p trend = 0.008). The trend test of VTE for shoulder joint was not statistically significant. (Figure 1)Adjusted logistic regression with a fifth degree orthogonal polynomial showed the seasonal pattern for the VTE in three joints separately. The three months after effect of three interventions (CG92 in January 2010; TA245 in January 2012; NG89 in March 2018) was examined in the polynomial model after adjusting for the seasonality and regions. No significant step change was seen because of the intervention in the trends of VTE for any joints other than Shoulder joint.

Conclusion: here was no significant change in the rate of VTE after the NICE guidelines introduced. Further study is needed to explore the economic benefits of the change in NICE guidelines.

Fugre-1 Polynomial regression plots with fitted mean for the trends of VTE incidence in the UK.

Blue line represents the fitted mean trends and the shadow represents the confidence interval. Grey shadow in the background shows the actual distribution with confidence interval against time (in months). Vertical splits represents the three months after the NICE guideline for VTE prevention was introduced (March 2010, March 2012, and June 2018).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/trends-of-venous-thromboembolism-after-total-joint-replacement-in-the-united-kingdom-after-the-introduction-of-nice-guidelines/