. 2024 Mar 12;14(1):5955.

doi: 10.1038/s41598-024-54916-x.

Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

Helen Badge^{1

2

3

4}, Tim Churches^{5

6}, Justine M Naylor^{7

5

6}, Wei Xuan^{5

6}, Elizabeth Armstrong⁸, Leeanne Gray⁹, John Fletcher^{10

11}, Iain Gosbell^{6

12}, Chung-Wei Christine Lin¹³, Ian A Harris^{7

5

6

9}

Affiliations

¹ Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071, Australia. helen.badgehawke@gmail.com.
² South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071, Australia. helen.badgehawke@gmail.com.
³ Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071, Australia. helen.badgehawke@gmail.com.
⁴ Australian Catholic University, 8-20 Napier Street, North Sydney, 2060, Australia. helen.badgehawke@gmail.com.
⁵ South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071, Australia.
⁶ Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071, Australia.
⁷ Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071, Australia.
⁸ School of Public Health, The University of New South Wales, UNSW Kensington Campus, 2033, Botany Street, Kensington, NSW, 2052, Australia.
⁹ South Western Sydney Local Health District, 1 Elizabeth Street, Liverpool, 2071, Australia.
¹⁰ University of Sydney, Fisher Road, Camperdown, NSW, 2006, Australia.
¹¹ Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
¹² Western Sydney University, Campbelltown, NSW, 2560, Australia.
¹³ Sydney School of Population Health, The University of Sydney, Edward Ford Building (A27) Fisher Road, Camperdown, NSW, 2006, Australia.

PMID: 38467650
PMCID: PMC10928067
DOI: 10.1038/s41598-024-54916-x

Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

Helen Badge et al. Sci Rep. 2024.

. 2024 Mar 12;14(1):5955.

doi: 10.1038/s41598-024-54916-x.

Authors

Affiliations

¹ Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071, Australia. helen.badgehawke@gmail.com.
² South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071, Australia. helen.badgehawke@gmail.com.
³ Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071, Australia. helen.badgehawke@gmail.com.
⁴ Australian Catholic University, 8-20 Napier Street, North Sydney, 2060, Australia. helen.badgehawke@gmail.com.
⁵ South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071, Australia.
⁶ Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071, Australia.
⁷ Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071, Australia.
⁸ School of Public Health, The University of New South Wales, UNSW Kensington Campus, 2033, Botany Street, Kensington, NSW, 2052, Australia.
⁹ South Western Sydney Local Health District, 1 Elizabeth Street, Liverpool, 2071, Australia.
¹⁰ University of Sydney, Fisher Road, Camperdown, NSW, 2006, Australia.
¹¹ Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
¹² Western Sydney University, Campbelltown, NSW, 2560, Australia.
¹³ Sydney School of Population Health, The University of Sydney, Edward Ford Building (A27) Fisher Road, Camperdown, NSW, 2006, Australia.

PMID: 38467650
PMCID: PMC10928067
DOI: 10.1038/s41598-024-54916-x

Abstract

Preventing avoidable venous-thrombo-embolism (VTE) is a priority to improve patient and service outcomes after total hip and total knee arthroplasty (THA, TKA), but compliance with relevant clinical guidelines varies. This study aims to determine the degree to which prophylaxis was compliant with Australian Orthopaedic Association (AOA) VTE prophylaxis guidelines and whether non-compliance is associated with increased risk of VTE. A prospective multi-centre cohort study of adults with osteoarthritis undergoing primary TKA/THA was completed at 19 high-volume public and private hospitals. Data were collected prior to surgery and for one-year post-surgery. Logistic regression was undertaken to explore associations between non-compliance with AOA VTE prophylaxis guidelines and symptomatic 90-day VTE outcomes. Data were analysed for 1838 participants from 19 sites. The rate of non-compliance with all clinical guideline recommendations was 20.1% (N = 369), with 14.1% (N = 259) non-compliance for risk-stratified prophylaxis, 35.8% (N = 658) for duration, and 67.8% (N = 1246) for other general recommendations. Symptomatic VTE was experienced up to 90-days post-surgery by 48 people (2.6%). Overall guideline non-compliance (AOR = 0.93, 95%CI = 0.4 to 1.3, p = 0.86) was not associated with a lower risk of symptomatic 90-day VTE. Results were consistent when people with high bleeding risk were excluded (AOR = 0.94, 95%CI = 0.44 to 2.34, p = 0.89). Non-compliance with the AOA VTE prophylaxis guidelines was not associated with risk of 90-day VTE after arthroplasty. This counterintuitive finding is concerning and necessitates a rigorous review of the AOA VTE prevention clinical guideline.

Keywords: Clinical guidelines; Primary total hip arthroplasty; Primary total knee arthroplasty; Prophylaxis; Surgical complications; Venous thromboembolism.

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Conflict of interest statement

IA is the scientific secretary of the AOA. JF is an unpaid member of the group that developed the NHMRC Guidelines for the prevention of VTE. All other declare no potential conflict of interest.

Figures

**Figure 1**
Participant recruitment, eligibility, and participation.

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Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

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Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

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