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Observational Study
. 2025 Sep 17:96:692-697.
doi: 10.2340/17453674.2025.44481.

Risk of perioperative mortality and venous thromboembolism after total hip or knee arthroplasty with recent COVID-19 infection: an observational study from the Kaiser Permanente Northern California Database

Aidan T Morrell  1 , Ryland P Kagan  1 , Mackenzie Kelly  1 , Graham J DeKeyser  1 , Andrew L Avins  2 , Lusine X Gigoyan  2 , John S Cox  3
Affiliations
Observational Study

Risk of perioperative mortality and venous thromboembolism after total hip or knee arthroplasty with recent COVID-19 infection: an observational study from the Kaiser Permanente Northern California Database

Aidan T Morrell et al. Acta Orthop. .

Abstract

Background and purpose: Limited data exist on venous thromboembolism (VTE) and mortality risk in patients undergoing primary total hip (THA) or knee arthroplasty (TKA) following recent COVID-19 infection. We aimed to evaluate whether the timing of COVID-19 infection affects postoperative VTE and mortality risk after THA or TKA.

Methods: Adult Kaiser Permanente Northern California members undergoing elective THA or TKA from 2020-2022 were identified using internal procedure codes. 33,520 patients with or without SARS-CoV-2 within 6 months preoperatively were compared. Multivariate Poisson regression was used to calculate incidence rate ratios (RRs) adjusted for demographics, comorbidities, and Covid vaccination status. The primary outcome was 90-day VTE (deep venous thrombosis or pulmonary embolism). The secondary outcome was 90-day mortality.

Results: Among patients with recent COVID-19, the 90-day VTE rate was 0.3%, and the mortality rate was 2.5%. Recent COVID-19 within 6 to 12 weeks preoperatively did not significantly increase 90-day VTE risk (RR 1.0, 95% confidence interval [CI] 0.38-2.8) but was associated with increased 90-day mortality risk (RR 3.1, CI 1.7-5.4).

Conclusion: Recent COVID-19 infection did not significantly impact VTE risk after THA or TKA. However, infection within 6 to 12 weeks preoperatively was associated with increased 90-day mortality.

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Conflict of interest statement

This study was conducted under approval by the Kaiser Permanente Northern California Institutional Review Board (approval #2056765). Data sharing is not possible due to existing regulation; however, requests for sub-analyses may be considered. This study was funded internally through the Kaiser Delivery Science and Applied Research Unit. Study funding did not influence the interpretation of data, reporting of results, writing of the manuscript, or decision to publish. Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article. Complete disclosure of interest forms according to ICMJE are available on the article page: 10.2340/17453674.2025.44481

Figures

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Patient study flow diagram.
See this image and copyright information in PMC

References

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