In-hospital VTE following primary THA was uncommon (0.19%) but concentrated among medically complex patients, with paralysis, lymphoma, other neurologic disorders, and pulmonary circulation disorders the strongest independent predictors.
The national incidence of in-hospital VTE after primary total hip arthroplasty was 0.19%.
Patients who developed VTE were older and more often Medicare-insured, and were more often treated at large and urban teaching hospitals.
Patients with VTE had a higher prevalence of multiple comorbidities at baseline than those without VTE.
Paralysis, lymphoma, other neurologic disorders, and pulmonary circulation disorders were the strongest independent predictors of in-hospital VTE.
Several additional comorbidities were independent predictors of VTE after adjustment, with more modest effect sizes.
The authors conclude that VTE after primary THA is concentrated among medically complex patients and that improved risk stratification may guide counseling, surveillance, and individualized thromboprophylaxis.
This study used a large U.S. national hospital database covering 2016 to 2022 to look at blood clots (deep vein thrombosis or pulmonary embolism) that occur during the hospital stay after a first-time total hip replacement. Among about 856,000 estimated hip replacement admissions, roughly 0.19% (1660 patients) developed a clot in the hospital, so it was uncommon. Patients who developed clots tended to be older, were more often covered by Medicare, and had more other health conditions. After accounting for other factors, the conditions most strongly linked with in-hospital clots were paralysis, lymphoma, other neurologic disorders, and disorders of the lung's blood circulation. Other linked conditions included peripheral vascular disease, autoimmune disease, heart failure, clotting disorders, anemia, an underactive thyroid, and obesity. This research suggests that clot risk after hip replacement is concentrated in patients with more complex medical histories. The authors propose that identifying these patients ahead of time could help guide discussions, monitoring, and tailored clot-prevention plans. Because the study used hospital billing data and looked only at clots during the hospital stay, it cannot show cause and effect or capture clots occurring after discharge.
Mastrokostas L, Mastrokostas P, Kucherina A, Tyagi A, Lama G, Magruder M. (2026). Predictors of in-hospital venous thromboembolism in patients undergoing primary total hip arthroplasty.. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. https://doi.org/10.1007/s00590-026-04998-2