Prior COVID-19 and Venous Thromboembolism Risk in Total Joint Arthroplasty in Patients Over 65 Years of Age

The COVID-19 pandemic has been associated with an increased risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). Data are lacking, however, on the impact of proposed prothrombotic states and complications after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We investigated 1) trends in VTE, PE, and DVT rates post-THA and TKA from 2016 to 2019 compared to 2020 to 2021 and 2) associations between prior COVID-19 diagnosis and VTE, PE, and DVT.A large national dataset was queried for patients who underwent elective THA and TKA from 2016 to 2021. We first assessed trends and differences between 2016 to 2019 and 2020 to 2021 in 90-day VTE prevalence. Second, we investigated associations between previous COVID-19 diagnosis and 90-day VTE using multivariable regression models.From 2016 to 2021, there were 2,422,051 total cases with an annual decreasing VTE prevalence from 2.2 to 1.9% (THA) and 2.5 to 2.2% (TKA). This was evident for both PE and DVT (all trend tests P<0.001). After adjusting for covariates (including vaccination status), prior COVID-19 was associated with significantly increased odds of developing VTE in TKA patients (Odds Ratio 1.2, 95% Confidence Interval 1.1 to 1.4, P=0.007), but not DVT or PE (P>0.05). There were no significant associations between prior COVID-19 and VTE, DVT, or PE after THA (P>0.05).Our study suggests that a previous diagnosis of COVID-19 is associated with increased odds of VTE, but not DVT or PE, in TKA patients. Ongoing monitoring of data is needed given our effect estimates, emerging COVID-19 variants, and evolving vaccination rates.