Estrogen Replacement Therapy Decreases Associated Risk of Postoperative Venous Thromboemboli and Medical Complications After Total Joint Arthroplasty.

ERT use before total hip arthroplasty was associated with decreased risk of deep vein thrombosis after propensity matching.

• OR 0.52 (CI 0.29 to 0.91, P = 0.028) for DVT in THA patients on ERT versus controls
• ERT cohort consisted of 3,425 THA patients (3.5% of total THA cohort) propensity matched to 6,850 controls
• Matching controlled for age, tobacco use, obesity, and diabetes diagnosis
• Study drew from 893,759 primary THA procedures from 2015 to 2020

ERT use before total hip arthroplasty was not associated with a statistically significant difference in pulmonary embolism risk.

• OR 0.67 (CI 0.34 to 1.32, P = 0.31) for PE in THA patients on ERT versus controls
• The confidence interval crossed 1.0, indicating no statistically significant difference
• Analysis was based on propensity-matched cohorts of 3,425 ERT patients and 6,850 controls

ERT use before total hip arthroplasty was associated with lower rates of major medical complications.

• OR 0.47 (CI 0.31 to 0.73, P < 0.001) for total medical complications in THA patients on ERT versus controls
• Analysis used propensity-matched data qualified with adjusted odds ratios and 95% confidence intervals

ERT use before total knee arthroplasty was associated with decreased risk of deep vein thrombosis.

• OR 0.60 (CI 0.44 to 0.82, P = 0.001) for DVT in TKA patients on ERT versus controls
• ERT cohort consisted of 7,409 TKA patients (3.5% of total TKA cohort) propensity matched to 14,818 controls
• Study drew from 1,660,909 primary TKA procedures from 2015 to 2020

ERT use before total knee arthroplasty was associated with decreased risk of pulmonary embolism.

• OR 0.56 (CI 0.37 to 0.83, P = 0.005) for PE in TKA patients on ERT versus controls
• This is in contrast to the THA findings where no significant difference in PE was observed
• Analysis was based on propensity-matched cohorts of 7,409 ERT patients and 14,818 controls

ERT use before total knee arthroplasty was associated with lower rates of major medical complications.

• OR 0.53 (CI 0.42 to 0.67, P < 0.001) for total medical complications in TKA patients on ERT versus controls
• Propensity matching controlled for age, tobacco use, obesity, and diabetes diagnosis

ERT is commonly held before arthroplasty due to perceived VTE risk, but the study found ERT was associated with decreased rather than increased VTE risk.

• ERT and TJA are described as prevalent in the geriatric population with limited prior evidence on postoperative outcomes
• Current clinical practice involves holding ERT before arthroplasty due to perceived VTE risk
• Approximately 3.5% of both THA and TKA patients in the database were prescribed ERT within 90 days before surgery

The study used a large national database with a retrospective design identifying procedures via ICD-10 codes from 2015 to 2020.

• Total sample included 893,759 primary THA and 1,660,909 TKA procedures
• ERT exposure was defined as prescription within 90 days before surgery
• Propensity matching was performed for age, tobacco use, obesity, and diabetes diagnosis
• Outcomes assessed included DVT, PE, and total major medical complications