This article was originally published here
BMC musculoskeletal disorder. July 6, 2021; 22 (1): 608. doi: 10.1186 / s12891-021-04453-9.
ABSTRACT
BACKGROUND: Venous thromboembolism (VTE) is a significant complication after joint replacement. Diabetes is related to some changes in clotting and fibrinolysis that can lead to thrombophilia. Our goal was to investigate the incidence of postoperative VTE and associated risk factors in patients with diabetes undergoing total hip (THA) or total knee anthroplasty (TKA) in a single center in China.
METHODS: Patients with diabetes who underwent THA or TKA from January 2016 to December 2018 (n = 400) at Beijing Jishuitan Hospital were enrolled in this study. Before and after surgery, venous Doppler ultrasound of the lower extremities was performed to confirm deep vein thrombosis (DVT). Computed tomography-pulmonary angiography was performed to confirm pulmonary embolism (PE) in patients with new postoperative DVT and typical symptoms of PE. A multivariate logistic regression model was performed 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 of 400). Of the 187 VTE patients, 7.5% (14 of 187) had a proximal vein thrombosis and 92.5% (173 of 187) had a distal vein thrombosis. There was no PE. Female patients and those who underwent TKA had a higher incidence of postoperative VTE. Patients who developed postoperative VTE were older and had higher preoperative D-Dimer and Caprini scores. A high preoperative D-dimer level (OR = 2.11, 95% CI = 1.35-3.30) and the operation of a TKA (OR = 2.29, 95% CI = 1.29-4.01) ) significantly increased the risk of developing postoperative VTE. The postoperative initiation of simultaneous 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 arthroplasty. Patients undergoing TKA or who have high preoperative D-dimer levels are at significant risk of developing postoperative VTE. The postoperative initiation of simultaneous mechanical prophylaxis and LMWH for VTE can play a protective role.
PMID: 34229632 | DOI: 10.1186 / s12891-021-04453-9
