Venous thromboembolism (VTE) is a serious complication following total knee arthroplasty (TKA), and a history of VTE is a recognized risk factor for subsequent thromboembolic events.

However, the effect of the timing of a prior VTE relative to TKA on postoperative complications remains unclear.

Purpose: To evaluate the association between prior VTE timing and postoperative DVT, pulmonary embolism (PE), readmission, and periprosthetic joint infection (PJI) following primary TKA.

 

Retrospective cohort study using a large national database of patients undergoing primary TKA.

Patients with prior VTE were stratified by the interval from VTE to TKA: 0–3, 3–6, 6–12, 12–18, 18–24 months, and yearly intervals up to 5 years.

Propensity-score matching (1:1) controlled for demographics and comorbidities.

The matched cohort included 22,447 patients with prior VTE and matched controls.

Outcomes included 90-day postoperative DVT, PE, hospital readmission, and 2-year PJI. Chi-square and Welch t-tests were used for statistical analysis.

Results:

Prior VTE was associated with markedly increased 90-day thromboembolic complications following TKA.

The risk of postoperative VTE increased as the VTE-to-surgery interval shortened, with the highest rates following a recent 0–3 month VTE.

Prior VTE was also associated with increased 2-year PJI risk (2.4% vs. 1.8%; OR 1.3 [95% CI, 1.2–1.5]).

Conclusion:

Prior VTE significantly increased the risk of 90-day DVT, 90-day PE, and 2-year PJI following primary TKA.

The risk of postoperative VTE was greatest when the interval between the prior VTE and TKA was shortest.

Patients with a recent history of VTE represent a particularly high-risk population when considering elective TKA.