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Rate of VTE after hip replacement is less than 1%

Clinical Question:
How common are venous thromboembolic events after hip replacement surgery?

Bottom Line:
Patients undergoing hip replacement surgery are at a higher risk of developing venous thromboembolism (VTE) than the general population, but the rate is still less than 1%. (LOE = 1b)

Reference:
Pedersen AB, Johnsen SP, Sørensen HT. Increased one-year risk of symptomatic venous thromboembolism following total hip replacement: A nationwide cohort study. J Bone Joint Surg Br 2012;94(12):1598-1603.  [PMID:23188898]

Study Design:
Cohort (prospective)

Funding:
Unknown/not stated

Setting:
Population-based

Synopsis:
These Danish researchers used national medical databases to evaluate the rate of VTE in nearly 86,000 patients undergoing hip replacement surgery. They report that the national hip arthroplasty registry contains more than 95% of all patients undergoing primary hip replacement surgery or revisions. Additionally, their national health registry contains data on all hospitalizations since 1977 and all inpatient and outpatient care, including emergency department visits, since 1995. In this study, the authors evaluated patients undergoing primary hip arthroplasty between 1995 and 2010. Additionally, for each surgical patient, they chose 3 living control patients matched for age and sex (slightly more than 250,000 control patients). Finally, for each group, the researchers evaluated whether the patients had a symptomatic VTE during the year after the index patients' surgery. Virtually all patients had received low-molecular-weight heparin during their postsurgical hospital stays, however, the authors don't comment on the use of posthospitalization VTE prophylaxis. In the first 90 days after surgery, 0.79% of patients undergoing hip replacement had VTE compared with 0.05% in the control group. During the subsequent 9 months, the rates were 0.29% and 0.12%, respectively. The authors also calculated a ton of relative risk ratios adjusting for age, sex, comorbidity, and so forth, and in virtually every comparison, patients undergoing hip replacement surgery had a higher relative risk of developing VTE than controls.

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