Key result
Total knee arthroplasty increased the risk of postoperative venous thromboembolism compared to total hip arthroplasty in patients with diabetes.
Why the study?
Venous thromboembolism is a significant complication after joint arthroplasty, and diabetes involves coagulation and fibrinolysis alterations that may cause thrombophilia.
Cohort (n=400)
No
In diabetic patients undergoing joint arthroplasty, the incidence of postoperative VTE is high (46.8%), with TKA and elevated preoperative D-dimer identified as significant risk factors.
Answers are grounded in this paper and cite their sources.
High VTE rates in diabetic arthroplasty patients support intensified prophylaxis; leaves open diabetes-specific risk independent of other factors.
BACKGROUND: Venous thromboembolism (VTE) is a significant complication after joint arthroplasty. Diabetes is related to a few changes in coagulation and fibrinolysis that may lead to thrombophilia. We aimed to investigate the incidence of postoperative VTE and associated risk factors among patients with diabetes undergoing total hip (THA) or total knee anthroplasty (TKA) in a single centre in China. METHODS: Patients with diabetes who underwent THA or TKA from January 2016 to December 2018 (n = 400) at Beijing Jishuitan Hospital were recruited in this study. Lower limb venous Doppler ultrasound was performed before and after surgery to confirm deep venous thrombosis (DVT). Computer tomography pulmonary angiography was done to confirm pulmonary embolism (PE) for those with new postoperative DVT and typical symptoms of PE. A multivariate logistic regression model was conducted to examine factors associated with the development of postoperative VTE. RESULTS: The overall incidence of postoperative VTE in patients with diabetes after THA or TKA was 46.8 % (187 out of 400). Among the 187 VTE patients, 7.5 % (14 out of 187) had proximal vein thrombosis and 92.5 % (173 out of 187) had distal vein thrombosis. No PE occurred. Female patients and patients undergoing TKA had higher incidence of postoperative VTE. Patients who developed postoperative VTE were older, and had higher levels of preoperative D-Dimer and Caprini score. A high level of preoperative D-dimer (OR = 2.11, 95 %CI = 1.35-3.30) and the surgery of TKA (OR = 2.29, 95 %CI = 1.29-4.01) significantly increased the risk of developing postoperative VTE. Postoperative initiation of concomitant mechanical prophylaxis and low molecular weight heparin (LMWH) was protective for postoperative VTE (OR = 0.56, 95 %CI = 0.37-0.86). CONCLUSIONS: VTE is common in patients with diabetes undergoing joint arthroplasty. Patients undergoing TKA or with a high level of preoperative D-dimer are at a considerable risk of developing postoperative VTE. There may be a protective role of postoperative initiation of concomitant mechanical prophylaxis and LMWH for VTE.
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Deng et al. (2021) conducted a cohort in Diabetes undergoing total hip or total knee arthroplasty (n=400). Total knee arthroplasty (TKA) vs. Total hip arthroplasty (THA) was evaluated on Postoperative venous thromboembolism (VTE) (OR 2.29, 95% CI 1.29-4.01, p=0.005). Total knee arthroplasty increased the risk of postoperative venous thromboembolism compared to total hip arthroplasty in patients with diabetes.
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