title: Are patients with preoperative air travel at higher risk for venous thromboembolism following primary total hip and knee arthroplasty?
abstract: BACKGROUND
  The advent of international medical travel has resulted in many patients travelling abroad to seek medical attention at foreign institutions. However, it is not known whether long-haul flights further increase the risk of VTE in patients who are to receive a joint replacement.
  
  
  OBJECTIVE
  We performed this retrospective cohort study to analyze if patients with preoperative air travel with a flight time more than four hours are at higher risk for VTE development following total knee or total hip athroplasty (THA) compared to patients without preoperative travel.
  
  
  METHODS
  Between January 2007 and December 2012, 245 patients were treated with either a primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) with preoperative air travel with a flight time more than 4 hours at our institution. One-hundred fifty five patients (n= 87 THA and n= 68 TKA) out of 245 patients met the inclusion and exclusion criteria and were included in this study. A total of 187 patients (n= 92 THA and n= 95 TKA) without bus, air or car travel longer than 30 minutes met the inclusion and exclusion criteria and were included in this study as controls.
  
  
  RESULTS
  Patients with preoperative air travel were not at higher risk for VTE development compared to patients without preoperative air travel following TKA (HR = 0.95; 95%CI = 0.14-6.52). Gender (HR = 0.41; 95%CI = 0.05-3.56) and age (HR = 3.77; 95%CI = 0.63-22.37) did not influence the VTE development in TKA patients.
  
  
  CONCLUSIONS
  Our study results show that preoperative air travel do not further increase the risk of VTE after TKA and THA.
authors: Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
authors: Mustafa
authors: M
authors: Citak
authors: Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.|Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Till Orla
authors: TO
authors: Klatte
authors: Department of Trauma Surgery, Hannover Medical School, Hannover, Germany.
authors: Eduardo M
authors: EM
authors: Suero
authors: Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
authors: Johannes
authors: J
authors: Lenhart
authors: Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
authors: Thorsten
authors: T
authors: Gehrke
authors: Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
authors: Daniel
authors: D
authors: Kendoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064870:Air Travel / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000453:epidemiology*
keywords: Deep vein thrombosis; air travel; long-haul flight; total hip arthroplasty; total knee arthroplasty