The authors declare that they have no competing interests.
ZHZ and BS conceived and designed the review. ZHZ performed the search, screening, and abstraction and the data analysis. JY, ZKZ, PDK and FXP provided validation (see Validation in Methods). All authors were involved in drafting and revising the manuscript, and all gave approval of the final version.
Risk factors for venous thromboembolism (VTE) of total joint arthroplasty (TJA) have been examined by many studies. A comprehensive systematic review of recent findings of high evidence level in this topic is needed.
We conducted a PubMed search for papers published between 2003 and 2013 that provided level-I and level-II evidences on risk factors for VTE of TJA. For each potential factors examined in at least three papers, we summarize the the number of the papers and confirmed the direction of statistically significant associations, e.g. “risk factor” “protective factor” or “controversial factor”.
Fifty-four papers were included in the systematic review. Risk factors found to be associated with VTE of both total hip arthroplasty and total knee arthroplasty included older age, female sex, higher BMI, bilateral surgery, surgery time > 2 hours. VTE history was found as a VTE risk factor of THA but an controversial factor of TKA. Cemented fixation as compared to cementless fixation was found as a risk factor for VTE only of TKA. TKA surgery itself was confirmed as a VTE risk factor compared with THA surgery.
This systematic review of high level evidences published in recent ten years identified a range of potential factors associated with VTE risk of total joint arthroplasty. These results can provide informations in this topic for doctors, patients and researchers.
Guyatt GH, Eikelboom JW, Gould MK, Garcia DA, Crowther M, Murad MH. Approach to outcome measurement in the prevention of thrombosis in surgical and medical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e185S–94. PubMedPubMedCentralCrossRef
Deitelzweig S. Preventing venous thromboembolic events after total hip arthroplasty: new developments in clinical practice. Hosp Pract (1995). 2012;40(2):79–87. CrossRef
Baser O. Prevalence and economic burden of venous thromboembolism after total hip arthroplasty or total knee arthroplasty. Am J Manag Care. 2011;17(1 Suppl):S6–8. PubMed
Lee CH, Cheng CL, Chang CH, Kao Yang YH, Lin LJ, Lin TC. Universal pharmacological thromboprophylaxis for total knee arthroplasty may not be necessary in low‐risk populations: a nationwide study in Taiwan. J Thrombosis and Haemostasis. 2012;10(1):56–63. CrossRef
Wright JG, Swiontkowski MF. Introducing a new Journal section: evidence-based orthopaedics. J Bone Joint Surg Am. 2000;82:759–60.
Bullock DP, Sporer SM, Shirreffs Jr TG. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am. 2003;85-A(10):1981–6. PubMed
Kim YH, Oh SH, Kim JS. Incidence and natural history of deep-vein thrombosis after total hip arthroplasty. A prospective and randomised clinical study. J Bone Joint Surg Br. 2003;85(5):661–5. PubMed
Navarro-Quilis A, Castellet E, Rocha E, Paz-Jiménez J, Planès A. Bemiparin Study Group in Knee Arthroplasty. Efficacy and safety of bemiparin compared with enoxaparin in the prevention of venous thromboembolism after total knee arthroplasty: a randomized, double-blind clinical trial. J Thromb Haemost. 2003;1(3):425–32. PubMedCrossRef
Jain V, Dhal AK, Dhaon BK. Deep vein thrombosis after total hip arthroplasty in Indian patients with and without enoxaparin. J Orth Surg. 2004;12:173–7. CrossRef
Dahl OE, Eriksson BI. Postoperative Melagatran/Ximelagatran for the Prevention of Venous Thromboembolism following Major Elective Orthopaedic Surgery : Effects of Timing of First Dose and Risk Factors for Thromboembolism and Bleeding Complications on Efficacy and Safety. Clin Drug Investig. 2005;25(1):65–77. PubMedCrossRef
Hitos K, Fletcher JP. Venous thromboembolism following primary total knee arthroplasty. Int Angiol. 2006;25(4):343–51. PubMed
Chotanaphuti T, Ongnamthip P, Silpipat S, Foojareonyos T, Roschan S, Reumthantong A. The prevalence of thrombophilia and venous thromboembolism in total knee arthroplasty. J Med Assoc Thai. 2007;90(7):1342–7. PubMed
Kim YH, Kim JS. The 2007 John Charnley Award. Factors leading to low prevalence of DVT and pulmonary embolism after THA: analysis of genetic and prothrombotic factors. Clin Orthop Relat Res. 2007;465:33–9. PubMed
Miyagi J, Funabashi N, Suzuki M, Asano M, Kuriyama T, Komuro I. Predictive indicators of deep venous thrombosis and pulmonary arterial thromboembolism in 54 subjects after total knee arthroplasty using multislice computed tomography in logistic regression models. Int J Cardiol. 2007;119(1):90–4. PubMedCrossRef
Lassen MR, Dahl O, Mismetti P, Zielske D, Turpie AG. SR123781A: a new once-daily synthetic oligosaccharide anticoagulant for thromboprophylaxis after total hip replacement surgery: the DRIVE (Dose Ranging Study in Elective Total Hip Replacement Surgery) study. J Am Coll Cardiol. 2008;51(15):1498–504. PubMedCrossRef
RE-MOBILIZE Writing Committee, Ginsberg JS, Davidson BL, Comp PC, Francis CW, Friedman RJ. Oral thrombin inhibitor dabigatran etexilate vs North American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery. J Arthroplasty. 2009;24(1):1–9. Jan. CrossRef
Jameson SS, Charman SC, Gregg PJ, Reed MR, van der Meulen JH. The effect of aspirin and low-molecular-weight heparin on venous thromboembolism after hip replacement: a non-randomised comparison from information in the National Joint Registry. J Bone Joint Surg Br. 2011;93(11):1465–70. Nov. PubMedCrossRef
Verhamme P, Tangelder M, Verhaeghe R, Ageno W, Glazer S, Prins M. TB-402 Study Group. Single intravenous administration of TB-402 for the prophylaxis of venous thromboembolism after total knee replacement: a dose-escalating, randomized, controlled trial. J Thromb Haemost. 2011;9(4):664–71. PubMedCrossRef
Wells PS, Borah BJ, Sengupta N, Supina D, McDonald HP, Kwong LM. Analysis of venous thromboprophylaxis duration and outcomes in orthopedic patients. Am J Manag Care. 2010;16(11):857–63. PubMed
Dy CJ, Wilkinson JD, Tamariz L, Scully SP. Influence of preoperative cardiovascular risk factor clusters on complications of total joint arthroplasty. Am J Orthop. 2012;40(11):560–5.
Sakao S, Tatsumi K. Crosstalk between endothelial cell and thrombus in chronic thromboembolic pulmonary hypertension: perspective. Histol Histopathol. 2013;28(2):185–93. PubMed
- Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II