A major increase of thromboembolic events in total hip and knee arthroplasty patients during the COVID-19 pandemic

ABSTRACT

Objectives

The first known COVID-19 patient in the United States was reported on 1/20/2020. Since then, we noted increased thromboembolic events among our THA/TKA patients. Therefore, we sought to determine: (1) monthly incidences of pulmonary embolism (PE)/deep vein thrombosis (DVT) before and after January/2020 and (2) thromboembolic event rates for primary and revision patients.

Methods

We retrospectively obtained from our electronic-medical-records the total monthly number of patients (December/2018-March/2021) who underwent primary or revision THA/TKA, and among them, those who had PE/DVT during each month. Monthly rates of thromboembolic events were calculated and figures were created showing rates throughout time. The cutoff month to define before and after COVID-19 was January/2020.

Results

During the study period, 1.6% of patients (312/19068) had PE/DVT [PE (n = 102), DVT (n = 242), both (n = 32)]. Overall rate of PE/DVT before January/2020 was 1.2% (119/9545) and it was 2.0% (193/9523) after that month. Incidences of PE/DVT on April/June/July of 2020 were 3.4%, 3%, 3.4%, respectively. A major increase, when compared to 2019 (1.3%, 1%, 1%, respectively). An unusually high rate of PE was observed on April/2020 (3.4%), more than three times the one observed in any other month. After January/2020, there was an overall major increase of PE/DVT rates, but particularly among revision patients: 6% in five different months including 11.5% on November/2020.

Conclusion

There was a major increase of thromboembolic events among THA/TKA patients during the COVID-19 pandemic, predominantly in revision patients. Patients need counseling about this increased risk. It remains uncertain whether more aggressive thromboprophylactic regimes should be followed.

KEYWORDS:

• COVID-19
• total hip arthroplasty
• total knee arthroplasty
• pulmonary embolism
• deep vein thrombosis

Declaration of funding

No funding was received for the production of this manuscript.

Disclosure of financial/other conflicts of Interest

Drs. Jesus M. Villa and Tejbir S. Pannu reported no biomedical financial interests or potential conflicts of interest. Dr. Carlos A. Higuera reports the following: American Association of Hip and Knee Surgeons, Mid-American Orthopaedic Association, Musculoskeletal Infection Society (Board or committee member), Journal of Arthroplasty, Journal of Bone and Joint infection, Journal of Hip Surgery, Journal of the American Academy of Orthopaedic Surgeons (Editorial or governing board), CD Diagnostics, Ferring Pharmaceuticals, Lyfstone, OREF, Orthofix, Inc., Stryker, Zimmer (Research support), KCI (Paid consultant; Paid presenter or speaker; Research support), and PSI (Stock or stock options). Dr. Aldo M. Riesgo reports the following: Stryker and Zimmer (Paid consultant). Dr. Nicolas S. Piuzzi reports the following: American Association of Hip and Knee Surgeons, ISCT, Orthopaedic Research Society (Board or committee member), Journal of Hip Surgery and Journal of Knee Surgery (Editorial or governing board), Regeneron and Stryker (Paid consultant), RegenLab and Zimmer (Research support). Dr. Viktor Krebs reports the following: Stryker (Paid consultant) and Journal of Arthroplasty (Board member). All disclosures outside the submitted work. The authors have no other relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.