Is There a Higher Risk of DVT for TKA Patients Who Had COVID-19?

Endothelial injury, a major cause of deep vein thrombosis (DVT) after surgery, has also been found in patients infected with COVID-19.

That prompted researchers from Hospital for Special Surgery (HSS) to investigate whether the risk of endothelial dysfunction continues after an infection with COVID-19 resolves, and whether there is a need for more-aggressive DVT prophylaxis in total knee arthroplasty (TKA) patients with a history of COVID-19.

“Postoperative thrombosis is always a concern in patients undergoing total knee arthroplasty. This has been attributed to endothelial dysfunction from Virchow’s triad,” said Kethy Jules-Elysee, MD, an anesthesiologist at HSS and the study’s lead author.

“Given the projected increase in demand of TKA surgeries and the continued rise of COVID-19 cases, it is significantly important to assess the risks of postoperative thrombosis in the setting of both TKA and previous COVID-19 infection.”

No Difference in Endothelial Function

For the study – presented at the 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine – the researchers identified 53 patients with SARS-CoV-2 antibodies 48 patients without the antibodies who were scheduled for primary TKA at HSS to treat osteoarthritis of the knee.

The researchers non-invasively measured endothelial function twice – once before surgery and once on POD1 – via a reactive hyperemia procedure with a VENDYS-II device. Endothelial function was quantified using the vascular reactivity index (VRI), with results ranging from 0 (poor) to 3.5 (excellent).

The researchers found no significant difference in endothelial function before or after TKA in patients who had recovered from COVID-19 compared with those who did not have the virus. In addition, postoperative VRI was not correlated with the duration or severity of COVID-19 infection. Decreased postoperative VRI was also not associated with increased length of hospital stay.

“[These] findings suggest no increased risk of DVT after TKA in SARS-CoV-2 IgG-positive patients,” Dr. Jules-Elysee said, indicating that more-aggressive DVT prophylaxis is likely not needed in TKA patients who have fully recovered from COVID-19.

When considering follow-up studies, Dr. Jules-Elysee noted that, “Since patients with a history of severe or prolonged infection with COVID-19 were not included in the study, further research on these patients is needed.”


Jules-Elysee K, Hanreich C, Boettner F, Jungwirth-Weinberger A, Zhao A, Schultz R, Bendich I, Mandl L. Risk of thromboembolic events as measured by endothelial function is not elevated in total knee replacement patients with history of COVID disease. (Poster 2624; a President’s Choice abstract). Presented at the 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), March 31-April 2, 2022, Las Vegas, Nevada.

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