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. 2020 Dec;79(12):1616-1624.
doi: 10.1136/annrheumdis-2020-217782. Epub 2020 Sep 16.

Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study

Chao Zeng  1   2   3   4   5 , Kim Bennell  6 , Zidan Yang  4 , Uyen-Sa D T Nguyen  7 , Na Lu  8 , Jie Wei  2   3   9 , Guanghua Lei  10   4   5 , Yuqing Zhang  11   3
Affiliations

Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study

Chao Zeng et al. Ann Rheum Dis. 2020 Dec.

Abstract

Objectives: Osteoarthritis is a leading cause of immobility and joint replacement, two strong risk factors for venous thromboembolism (VTE). We aimed to examine the relation of knee, hip and hand osteoarthritis to the risk of VTE and investigate joint replacement as a potential mediator.

Methods: We conducted three cohort studies using data from The Health Improvement Network. Up to five individuals without osteoarthritis were matched to each case of incident knee (n=20 696), hip (n=10 411) or hand (n=6329) osteoarthritis by age, sex, entry time and body mass index. We examined the relation of osteoarthritis to VTE (pulmonary embolism and deep vein thrombosis) using a multivariable Cox proportional hazard model.

Results: VTE developed in 327 individuals with knee osteoarthritis and 951 individuals without osteoarthritis (2.7 vs 2.0 per 1000 person-years), with multivariable-adjusted HR being 1.38 (95% CI 1.23 to 1.56). The indirect effect (HR) of knee osteoarthritis on VTE through knee replacement was 1.07 (95% CI 1.01 to 1.15), explaining 24.8% of its total effect on VTE. Risk of VTE was higher in hip osteoarthritis than non-osteoarthritis (3.3 vs 1.8 per 1000 person-years; multivariable-adjusted HR=1.83, 95% CI 1.56 to 2.13). The indirect effect through hip replacement yielded an HR of 1.14 (95% CI 1.04 to 1.25), explaining 28.1% of the total effect. No statistically significant difference in VTE risk was observed between hand osteoarthritis and non-osteoarthritis (1.5 vs 1.6 per 1000 person-years; multivariable-adjusted HR=0.88, 95% CI 0.67 to 1.16).

Conclusion: Our large population-based cohort study provides the first evidence that knee or hip osteoarthritis, but not hand osteoarthritis, was associated with an increased risk of VTE, and such an association was partially mediated through knee or hip replacement.

Keywords: epidemiology; knee; osteoarthritis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cumulative incidence of venous thromboembolism (A), pulmonary embolism (B) and deep vein thrombosis (C) in 20 696 individuals with incident knee OA as compared with 81 137 individuals without OA, matched by age, sex, entry time and BMI. BMI, body mass index; OA, osteoarthritis.
Figure 2
Figure 2
Cumulative incidence of venous thromboembolism (A), pulmonary embolism (B) and deep vein thrombosis (C) in 10 411 individuals with incident hip OA as compared with 41 594 individuals without OA, matched by age, sex, entry time and BMI. BMI, body mass index; OA, osteoarthritis.
Figure 3
Figure 3
Cumulative incidence of venous thromboembolism (A), pulmonary embolism (B) and deep vein thrombosis (C) in 6329 individuals with incident hand OA as compared with 25 206 individuals without OA, matched by age, sex, entry time and BMI. BMI, body mass index; OA, osteoarthritis.
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