Transfusions are Associated with an Elevated Risk of Venous Thromboembolism and Periprosthetic Joint Infection following Revision Total Knee Arthroplasty.

INTRODUCTION: Blood transfusions have been associated with an increased risk of venous thromboembolism (VTE) and infectious complications following primary total joint arthroplasty. However, the thrombogenic and immunomodulatory effects associated with transfusions in the revision knee arthroplasty population have not been quantified. Accordingly, the present study sought to evaluate VTE and infectious complications between transfused and non-transfused patients following aseptic both-component revision total knee arthroplasty (TKA).

METHODS: A national healthcare database, capturing approximately one-quarter of all procedures performed in the United States, was queried to identify patients undergoing aseptic both-component revision TKA from 2016 to 2023. Patients who received transfusions were matched to non-recipients. Cohorts were balanced on patient demographics, comorbidities, postoperative VTE chemoprophylactic agents, tranexamic acid (TXA) utilization, dexamethasone administration, and hospital characteristics. The 90-day risk of VTE complications, including deep vein thrombosis (DVT) and pulmonary embolism (PE), and infectious complications, including periprosthetic joint infection (PJI), were assessed using multivariable logistic regression models to account for residual confounding. In total, 2,228 patients who received transfusions were 1:1 matched to 2,228 non-recipients who had good balance (standardized mean differences less than 0.10). Transfusion recipients and non-recipients demonstrated an average age of 72 years and had similar rates of dexamethasone (57.0 versus 57.4%), TXA (64.8 versus 63.8%), aspirin (29.5 versus 28.5%), and low-molecular weight heparin utilization (29.7 versus 32.9%).

RESULTS: Patients who received transfusions demonstrated higher rates of PE (2.4 versus 1.4%, adjusted odds ratio (aOR): 1.79, 95% confidence interval (CI): 1.13 to 2.82, P = 0.013) and DVT (3.6 versus 2.0%, aOR: 1.89, 95% CI: 1.29 to 2.78, P = 0.001). Moreover, transfusion administration was associated with an increased risk of PJI (5.3 versus 2.5%, aOR: 2.19, 95% CI: 1.57 to 3.00, P < 0.001).

DISCUSSION: Postoperative blood products are associated with markedly increased rates of PE and VTE and infectious complications following revision TKA. These data should inform blood conservation protocols and transfusion thresholds in this patient population.