Early thromboembolic events ≤ 1 week after fast-track total hip and knee arthroplasty

Introduction Thromboembolic events (TEE) are serious complications after total hip (THA) and knee arthroplasty (TKA), with reported in-hospital incidences of about 0.5-1% for venous thromboembolic events (VTE) and 0.2% for myocardial infarctions (MI) and stroke. However, little data exist on in-hospital TEE when using a standardized fast-track protocol with early mobilization. Materials and methods A large detailed cohort study in primary unilateral THA and TKAs on "early" (in-hospital or after discharge but within 1 week of surgery) and 30-days TEEs, including prospective recording of patient characteristics, complete follow-up through the Danish National Patient Register, and detailed evaluation on disposing factors and consequences of "early" TEEs through review of medical records. Results In 13,775 procedures with a median LOS of 2 days, 43 (0.32%; 95% CI: 0.23-0.42) "early" and 90 (0.65%; 95% CI: 0.53-0.80) 30-day TEEs were recorded. "Early" TEEs consisted of 9 (0.07%; 95% CI: 0.04-0.13) MI, 10 (0.08% 95% CI: 0.04-0.13) strokes, 13 (0.09%; 95% CI: 0.05-0.16) pulmonary embolisms and 11 (0.08%; 95% CI: 0.04-0.15) deep venous thromboses. Most TEEs were in patients with irreversible dispositions (e.g. previous TEE, high age and cardiac disease), but 5 of 9 MIs were associated with postoperative anemia. All in-hospital VTE (n: 16) occurred while patients received recommended thromboprophylaxis. Conclusions Incidence of "early" TEEs after fast-track THA and THA is low, but MIs may be further reduced by improving perioperative treatment of anemia. Further research is needed regarding interventions for prevention of "early" TEE in disposed patients.