Venous thromboembolism after fast-track elective revision hip and knee arthroplasty - A multicentre cohort study of 2814 unselected consecutive procedures.

Abstract

BACKGROUND\nVenous thromboembolism (VTE) prophylaxis is much debated within total hip and knee arthroplasty (THA/TKA). Revision hip and knee arthroplasty (rTHA/rTKA) are more extensive procedures, but data on the risk of postoperative VTE is conflicting and there are no specific guidelines for thromboprophylaxis. Furthermore, data on rTHA/rTKA within a fast-track protocol is sparse. Thus, we aimed at evaluating the incidence and time course of VTE in unselected elective rTHA/rTKA within our established multicentre fast-track collaboration with in-hospital only thromboprophylaxis if length of stay (LOS)\u202f≤\u202f5\u202fdays.\n\n\nMETHODS\nWe used an observational study design of unselected consecutive fast-track elective major component rTHA/rTKA from 6 dedicated fast-track centres between 2010 and 2018. We obtained information on revisions through Danish hip and knee arthroplasty registers and complete (>99%) 90\u202fdays follow-up through the Danish National Patient Registry in combination with chart review.\n\n\nRESULTS\nWe included 2814 procedures with median LOS 3\u202fdays [2-5] and 21% had LOS >5\u202fdays. The 90-day incidence of VTE was 0.42% (n\u202f=\u202f12), with 8 (0.28%) DVT and 4 (0.14%) PE, after median 14\u202fdays [IQR: 11-23] with the latest on day 31.\n\n\nCONCLUSION\nThe 90-day incidence of VTE after elective fast-track rTHA and rTKA was about 0.4% which is comparable to the 90-day VTE incidence after primary fast-track THA, TKA and unicompartmental knee arthroplasty. Future investigations should focus on identification of high-risk patients while the surgical trauma per se may be less important.