Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2024 | Phlebothrombosis | Research article

Incidence and risk factors of perioperative deep vein thrombosis in patients undergoing primary hip arthroplasty via the direct anterior approach

Authors: Zaikai Zhuang, Qiangqiang Li, Yao Yao, Ying Shen, Dongyang Chen, Qing Jiang

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

Deep vein thrombosis (DVT) is a frequent complication following hip arthroplasty. There still has been a lack of studies analyzing the perioperative risk factors of DVT following hip arthroplasty via direct anterior approach (DAA).

Methods

Patients who underwent unilateral primary hip arthroplasty via DAA in our hospital from August 2015 to January 2022 were included. Patients’ data, including demographic data, clinical features, past medical history, operative data, and laboratory data, were analyzed and compared between patients with and without DVT. Logistic regression analysis was conducted to identify the independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to assess the best cutoff value of continuous variables with statistical significance.

Result

A total of 651 patients were included. The incidence of DVT before and after hip arthroplasty was 12.7% and 6.7%, respectively. Logistic regression analysis indicated that age ≥ 65 years (OR 4.594, 95% CI 1.994–10.587), women (OR 2.331, 95% CI 1.285–4.227), and cerebral infarction (OR 1.984, 95% CI 1.138–3.460) were independent risk factors for preoperative DVT. And age ≥ 65 years (OR 4.859, 95% CI 1.062–22.226), tumor (OR 3.622, 95% CI 1.108–11.841), and preoperative D-dimer (OR 1.040, 95% CI 1.004–1.078) were risk factors for postoperative DVT. The ROC curve analysis showed that the best cutoff value of preoperative D-dimer for the diagnosis of postoperative DVT is 1.44 mg/L.

Conclusions

The incidence of DVT in patients undergoing DAA hip arthroplasty was low and the occurrence of DVT before and after unilateral primary hip arthroplasty performed through DAA was related to multiple factors.

Ferguson RJ, Palmer AJR, Taylor A, et al. Hip replacement. The Lancet. 2018;392:1662–71.CrossRef

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. The Lancet. 2007;370:1508–19.CrossRef

Schwartz BE, Piponov HI, Helder CW, et al. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop. 2016;40:1793–802.PubMedCrossRef

Lorenzoni L, Belloni A, Sassi F. Health-care expenditure and health policy in the USA versus other high-spending OECD countries. The Lancet. 2014;384:83–92.CrossRef

Zhou Z, Li Y, Peng Y et al. Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: a systematic review and meta-analysis based on RCTs. Front Surg 2022; 9: 1022937.

Sun X, Zhao X, Zhou L, et al. Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period. J Orthop Surg Res. 2021;16:69.PubMedPubMedCentralCrossRef

Awad ME, Farley BJ, Mostafa G, et al. Direct anterior approach has short-term functional benefit and higher resource requirements compared with the posterior approach in primary total hip arthroplasty : a meta-analysis of functional outcomes and cost. Bone Joint J. 2021;103-B(6):1078–87.PubMedCrossRef

Xu H, Zhang S, Xie J, et al. A nested case-control study on the risk factors of deep vein thrombosis for Chinese after total joint arthroplasty. J Orthop Surg Res. 2019;14:188.PubMedPubMedCentralCrossRef

Howard TA, Judd CS, Snowden GT, et al. Incidence and risk factors associated with venous thromboembolism following primary total hip arthroplasty in low-risk patients when using aspirin for prophylaxis. Hip Int. 2022;32:562–7.PubMedCrossRef

10.

Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2008;133:381S-453S.PubMedCrossRef

11.

Popuri RK, Vedantham S. The role of thrombolysis in the clinical management of deep vein thrombosis. Arterioscler Thromb Vasc Biol. 2011;31:479–84.PubMedPubMedCentralCrossRef

12.

Kahn SR, Shbaklo H, Lamping DL, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost. 2008;6:1105–12.PubMedCrossRef

13.

Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol. 2009;145:286–95.PubMedCrossRef

14.

Hughes MJ, Stein PD, Matta F. Silent pulmonary embolism in patients with distal deep venous thrombosis: systematic review. Thromb Res. 2014;134:1182–5.PubMedCrossRef

15.

Abe K, Kuklina EV, Hooper WC, et al. Venous thromboembolism as a cause of severe maternal morbidity and mortality in the United States. Semin Perinatol. 2019;43:200–4.PubMedPubMedCentralCrossRef

16.

Beckman MG, Hooper WC, Critchley SE, et al. Venous thromboembolism: a public health concern. Am J Prev Med. 2010;38:S495-501.PubMedCrossRef

17.

Kawai T, Goto K, Kuroda Y, Matsuda S. Lower activity and function scores are associated with a higher risk of preoperative deep venous thrombosis in patients undergoing total hip arthroplasty. J Clinic Med. 2020;9(5):1257.CrossRef

18.

Yukizawa Y, Inaba Y, Kobayashi N, et al. Current risk factors for asymptomatic venous thromboembolism in patients undergoing total hip arthroplasty. Mod Rheumatol. 2019;29:874–9.PubMedCrossRef

19.

Wakabayashi H, Hasegawa M, Niimi R, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients undergoing total hip arthroplasty. Thromb Res. 2015;136:855–8.PubMedCrossRef

20.

Zhang H, Mao P, Wang C, et al. Incidence and risk factors of deep vein thrombosis (DVT) after total hip or knee arthroplasty: a retrospective study with routinely applied venography. Blood Coagul Fibrinolysis. 2017;28:126–33.PubMedCrossRef

21.

Yu X, Wu Y, Ning R. The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care. BMC Musculoskelet Disord. 2021;22:547.PubMedPubMedCentralCrossRef

22.

Lin WK, Richillo D, Hui LK, et al. Incidence of deep vein thrombosis following total hip arthroplasty: a doppler ultrasonographic study. J Orthop Surg. 2011;19(1):50–3.CrossRef

23.

Stamatakis JD, Kakkar VV, Sagar S, et al. Femoral vein thrombosis and total hip replacement. BMJ. 1977;2(6081):223–5.PubMedPubMedCentralCrossRef

24.

Binns M, Pho R. Femoral vein occlusion during hip arthroplasty. Clin Orthop Relat Res. 1990;255:168–72.CrossRef

25.

Wang Z, Hou JZ, Wu CH, et al. A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. J Orthop Surg Res. 2018;13:229.PubMedPubMedCentralCrossRef

26.

Yang XT, Huang HF, Sun L, et al. Direct anterior approach versus posterolateral approach in total hip arthroplasty: a systematic review and meta-analysis of randomized controlled studies. Orthop Surg. 2020;12:1065–73.PubMedPubMedCentralCrossRef

27.

Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12:464–74.PubMedPubMedCentralCrossRef

28.

Cronin M, Dengler N, Krauss ES, et al. Completion of the updated caprini risk assessment model (2013 version). Clin Appl Thromb Hemost. 2019;25:1076029619838052.PubMedPubMedCentralCrossRef

29.

Migita K, Bito S, Nakamura M, et al. Venous thromboembolism after total joint arthroplasty: results from a Japanese multicenter cohort study. Arthritis Res Ther. 2014;16(4):R154.PubMedPubMedCentralCrossRef

30.

Yoo MC, Cho YJ, Ghanem E, et al. Deep vein thrombosis after total hip arthroplasty in Korean patients and D-dimer as a screening tool. Arch Orthop Trauma Surg. 2009;129:887–94.PubMedCrossRef

31.

Gascho JA, Fanelli C, Zelis R. Aging reduces venous distensibility and the venodilatory response to nitroglycerin in normal subjects. Am J Cardiol. 1989;63(17):1267–70.PubMedCrossRef

32.

Fuji T, Akagi M, Abe Y, et al. Incidence of venous thromboembolism and bleeding events in patients with lower extremity orthopedic surgery: a retrospective analysis of a Japanese healthcare database. J Orthop Surg Res. 2017;12:55.PubMedPubMedCentralCrossRef

33.

Basques BA, Bell JA, Fillingham YA, et al. Gender differences for hip and knee arthroplasty: complications and healthcare utilization. J Arthroplasty. 2019;34(1593–1597):e1591.

34.

Scarabin PY. Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis. Climacteric. 2018;21:341–5.PubMedCrossRef

35.

Oliver-Williams C, Glisic M, Shahzad S, et al. The route of administration, timing, duration and dose of postmenopausal hormone therapy and cardiovascular outcomes in women: a systematic review. Hum Reprod Update. 2019;25:257–71.PubMedCrossRef

36.

Andre C, de Freitas GR, Fukujima MM. Prevention of deep venous thrombosis and pulmonary embolism following stroke: a systematic review of published articles. Eur J Neurol. 2007;14:21–32.PubMedCrossRef

37.

Turpie AG. Prophylaxis of venous thromboembolism in stroke patients. Semin Thromb Hemost. 1997;23(2):155–7.PubMedCrossRef

38.

Hu L, Liu G. Effects of early rehabilitation nursing on neurological functions and quality of life of patients with ischemic stroke hemiplegia. Am J Transl Res. 2021;13(4):3811–8.PubMedPubMedCentral

39.

Blom JW, Doggen CJ, Osanto S, et al. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715–22.PubMedCrossRef

40.

Rickles FR, Falanga A. Activation of clotting factors in cancer. Cancer Treat Res. 2009;148:31–41.PubMedCrossRef

41.

Rinde FB, Fronas SG, Ghanima W, et al. D-dimer as a stand-alone test to rule out deep vein thrombosis. Thromb Res. 2020;191:134–9.PubMedCrossRef

42.

Kruger PC, Eikelboom JW, Douketis JD, et al. Deep vein thrombosis: update on diagnosis and management. Med J Aust. 2019;210:516–24.PubMedCrossRef

43.

Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349(13):1227–35.PubMedCrossRef

44.

Caprini JA, Glase CJ, Anderson CB, et al. Laboratory markers in the diagnosis of venous thromboembolism. Circulation. 2004;109:I4-8.PubMedCrossRef

45.

Sartori M, Cosmi B, Legnani C, et al. The Wells rule and D-dimer for the diagnosis of isolated distal deep vein thrombosis. J Thromb Haemost. 2012;10:2264–9.PubMedCrossRef

46.

An TJ, Engstrom SM, Oelsner WK, et al. Elevated D-dimer is not predictive of symptomatic deep venous thrombosis after total joint arthroplasty. J Arthroplasty. 2016;31:2269–72.PubMedCrossRef

47.

Shimoyama Y, Sawai T, Tatsumi S, et al. Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty. J Clin Anesth. 2012;24:531–6.PubMedCrossRef

48.

Engbers MJ, Blom JW, Cushman M, et al. Functional impairment and risk of venous thrombosis in older adults. J Am Geriatr Soc. 2017;65(9):2003–8.PubMedCrossRef

49.

Nakanishi K, Kanda T, Kobata T, et al. New score including daily life independence levels with dementia is associated with the onset of deep vein thrombosis in frail older adults. Geriatr Gerontol Int. 2020;20(5):414–21.PubMedCrossRef

Title: Incidence and risk factors of perioperative deep vein thrombosis in patients undergoing primary hip arthroplasty via the direct anterior approach
Authors: Zaikai Zhuang
Qiangqiang Li
Yao Yao
Ying Shen
Dongyang Chen
Qing Jiang
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Phlebothrombosis
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-023-04443-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence and risk factors of perioperative deep vein thrombosis in patients undergoing primary hip arthroplasty via the direct anterior approach

Abstract

Background

Methods

Result

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Result

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Comparison of different degrees of varus deformity correction with open-wedge high tibial osteotomy: a retrospective study over 5 years

Intelligent robot-assisted fracture reduction system for the treatment of unstable pelvic fractures

Medial patellar ligament reconstruction in combination with derotational distal femoral osteotomy for treating recurrent patellar dislocation in the presence of increased femoral anteversion: a systematic review

Critical distance of the sacroiliac joint for open reduction using screw fixation for traumatic sacroiliac joint diastasis: a retrospective study

Biomimetic design and clinical application of Ti-6Al-4V lattice hemipelvis prosthesis for pelvic reconstruction

The efficacy of pericapsular nerve group block for reducing pain and opioid consumption after total hip arthroplasty: a systematic review and meta-analysis