title: Venous Thromboembolic Disease in Revision vs Primary Total Knee Arthroplasty.
abstract: Venous thromboembolic disease (VTED) is a serious complication of primary and revision total knee arthroplasty (TKA). However, the incidence and risk of VTED for revision compared with primary TKA cases have not been well-described.
  
  
  
  We identified 225,584 TKAs (208,954 primaries, 16,630 revisions) in the 2003-2012 Statewide Planning and Research Cooperative System database. Odds ratios (ORs) expressed the risk of VTED for revision vs primary TKA, and models were adjusted for age, gender, race, and Charlson comorbidity scores. Outcome analyses were further stratified into deep venous thromboses (DVTs) and pulmonary emboli (PEs).
  
  
  
  The incidence of VTED within 30 days was 2.24% for primary and 1.84% for revision. In multivariable-adjusted regression, the OR of VTED within 30 days for revision compared with primary was 0.81 (95% confidence interval = 0.72-0.91; P < .001). The incidence of VTED within 90 days was 2.42% for primary and 2.13% for revision (P = .022), with a multivariable-adjusted OR of 0.87 (95% confidence interval = 0.78-0.97; P = .010) for revision compared with primary. The association was stronger for PE (OR = 0.63; P < .001) than DVT (OR = 0.87; P = .035) at 30 days, and significant for PE (OR = 0.69; P < .001), but not DVT (OR = 0.94; P = .284) at 90 days.
  
  
  
  In a large statewide database, the risk of VTED was lower for revision TKA compared with primary TKA. The reasons for this observation are not known, but might be related to aggressive prophylactic management of patients undergoing revision procedures. Future studies should attempt to clarify differences in patient selection and management for primary vs revision procedures.
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Boylan
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Dean C
authors.initials: DC
authors.lastname: Perfetti
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Carl B
authors.initials: CB
authors.lastname: Paulino
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000517:prevention & control*; D013923:Thromboembolism / Q000150:complications*; D020246:Venous Thrombosis / Q000517:prevention & control*
keywords: DVT; PE; arthroplasty; knee; revision; thromboembolic