Knee, Hip Osteoarthritis Linked to Increased VTE Risk

Sarfaroj Khan 


September 29, 2020


  • Knee or hip osteoarthritis (OA), but not hand OA, was associated with an increased risk of venous thromboembolism (VTE).

  • An increased risk of VTE in knee or hip OA was partly mediated through knee or hip replacement.

Why this matters

  • Findings, if confirmed by other studies, will help identify a large proportion of high-risk population for VTE given that knee and hip OA are common in older individuals.

Study design

  • 3 matched cohort studies using data from The Health Improvement Network (THIN) database, UK.

  • Patients with incident knee (n=20,696), hip (n=10,411) or hand (n=6329) OA were matched with up to 5 individuals without OA.

  • Primary outcome: VTE (composite of pulmonary embolism and deep vein thrombosis).

  • Funding: National Natural Science Foundation of China and others.

Key results

  • The risk of VTE was higher in patients with knee OA vs those without (incidence rate, 2.7 vs 2.0 per 1000 person-years; adjusted HR [aHR], 1.38; 95% CI, 1.23-1.56).

  • The indirect effect through knee replacement yielded an HR of 1.07 (95% CI, 1.01-1.15), explaining 24.8% of the total effect.

  • Similarly, the risk of VTE was greater in patients with hip OA vs those without (incidence rate, 3.3 vs 1.8 per 1000 person-years; aHR, 1.83; 95% CI, 1.56-2.13).

  • The indirect effect (HR) of hip OA on VTE through hip replacement was 1.14 (95% CI, 1.04-1.25), explaining 28.1% of its total effect on VTE.

  • No significant difference was observed in VTE risk between patients with hand OA vs those without (incidence rate, 1.5 vs 1.6 per 1000 person-years; aHR, 0.88; 95% CI, 0.67-1.16).


  • Risk of misclassification bias and residual confounding.


Zeng C, Bennell K, Yang Z, Nguyen UDT, Lu N, Wei J, Lei G, Zhang Y. Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study. Ann. Rheum. Dis.2020 Sep 16 [Epub ahead of print]. doi: 10.1136/annrheumdis-2020-217782. PMID: 32938637.  View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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