Untreated varicose veins (VV) significantly increase the risk of postoperative deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). However, the risk of DVT is the same for patients with surgically treated VV as for patients with no previous history of VV problems, according to study data presented by Anahita Dua, MD, at the AAOS 2012 Annual Meeting. The study also found that these effects do not occur in total knee arthroplasty (TKA) patients, and do not translate to an increased risk of pulmonary embolism (PE) in either THA or TKA patients.

“Although we freely quote varicose veins as a risk factor for DVT after lower limb arthroplasty, few studies have attempted to quantify the importance of varicose veins in regard to that risk,” said Dr. Dua. “Our study aim was to determine whether varicose veins are truly a risk factor for DVT in THA and TKA patients and whether prior diagnosis or surgical treatment of varicose veins alters the risk of DVT or PE after arthroplasty. This is important because most THA/TKA patients are elderly and both varicose veins and postoperative DVT are common diseases in this cohort.”

The researchers analyzed data from the Scottish arthroplasty registry, cross-referenced with hospital morbidity data, on patients who underwent THA (n = 57,364) and TKA (n = 51,859) between 1989 and 2009 and compared postoperative DVT and PE rates for each cohort. They divided the cohorts into the following groups:

• Patients with no previous VV diagnosis or VV surgeries (Group A)
• Patients with previous VV diagnosis and VV surgery (Group B)
• Patients with previous VV diagnosis but no VV surgery (Group C)

In the THA cohort, 462 patients had been diagnosed with DVT within 90 days of surgery, 403 patients had a 90-day PE diagnosis, and 829 patients had both DVT and PE. The DVT rate in Groups A and B was 0.8 percent, compared to a rate of 3.1 percent (P = 0.001) in Group C. The researchers found no statistically significant differences in postoperative PE or DVT/PE rates among the three groups.

In the TKA cohort, 304 patients had been diagnosed with DVT within 90 days of surgery, 411 patients had a 90-day PE diagnosis, and 691 patients had both DVT and PE. The researchers found no statistically significant differences in the DVT, PE, or DVT/PE rates among the three groups.

The authors admit that their study was limited by the fact that ICD codes were used to capture data and that laterality was not documented thoroughly. In addition, the patient sample size was confined to Scotland, and postoperative DVT prophylaxis, which is variable among hospitals within the country, was not controlled in the study. Based on their analysis, however, they concluded that varicose vein intervention prior to THA can significantly reduce the risk of postoperative DVT.

“I believe that varicose vein treatment can potentially prevent a DVT from developing in a THA patient, thereby reducing morbidity and even mortality from the THA procedure,” said Dr. Dua.

Dr. Dua’s coauthors of “Does previous varicose vein surgery alter the deep vein thrombosis risk after lower limb arthroplasty?” are N. Santiago (National Services Scotland) and Alisdair G. Sutherland, MD, FRCS (Ortho), MB, ChB (no conflicts). Dr. Dua reported no conflicts.

Maureen Leahy is the assistant managing editor of AAOS Now; she can be reached at leahy@aaos.org

Bottom Line

• This retrospective study analyzed whether varicose veins are a risk factor for DVT in THA and TKA patients, and whether prior varicose vein diagnosis or surgery alters the risk of DVT or PE after arthroplasty.
• Researchers found that untreated varicose veins are associated with an increased risk of DVT after THA, but did not find a similar correlation in TKA patients.
• An increased risk of PE in patients with a diagnosis of varicose veins was not found, regardless of whether vein treatment had been undertaken.
• Researchers recommend that patients with varicose veins should consider treatment prior to undergoing THA.

Additional Resources
Is Previous Varicose Vein Surgery Associated with Deep Vein Thrombosis within 90 Days of Hip and Knee Replacement?