Occurrence and predictors of deep vein thrombosis before total knee arthroplasty

Purpose Preoperative deep vein thrombosis (DVT) is a major concern in patients undergoing total knee arthroplasty (TKA) because existing thrombi may progress perioperatively, increasing the risk of venous thromboembolism. This study evaluated the prevalence of preoperative DVT and identified associated clinical and laboratory risk factors in patients scheduled for primary TKA. Methods This retrospective observational study included 565 consecutive patients undergoing primary TKA. Patients with a history of DVT or undergoing simultaneous bilateral TKA were excluded. All patients underwent preoperative duplex ultrasonography for DVT screening. Demographic characteristics, comorbidities, and laboratory findings were compared between patients with and without DVT. Variables that were significant in univariate analyses were entered into a multivariable logistic regression model. Receiver operating characteristic curve analyses were used to determine optimal cutoff values. Results Preoperative DVT was detected in 40 patients (7.1%). Compared with those without DVT, patients with DVT were significantly older, had lower body mass index (BMI), had a higher prevalence of rheumatoid arthritis (RA), had lower serum albumin levels, and had higher D-dimer levels. Multivariable analysis identified older age [odds ratio (OR), 1.066; p = 0.018], lower BMI (OR, 0.800; p < 0.001), RA (OR, 3.242; p = 0.014), and higher D-dimer levels (OR, 1.177; p = 0.049) as independent factors associated with preoperative DVT. Optimal cutoff values were 72.5 years for age, 22.8 kg/m 2 for BMI, and 0.85 μg/mL for D-dimer. Conclusions Preoperative DVT was identified in 7.1% of patients undergoing TKA. Older age, lower BMI, RA, and elevated D-dimer levels were independently associated with DVT and may help identify patients who could benefit from targeted preoperative screening and risk stratification.