Efficacy and Safety of Mechanical IVC filtration for Preventing Pulmonary Embolism in High-Risk Orthopedic Patients Undergoing Total Hip or Knee Arthroplasty

Abstract: Background To determine the efficacy and safety of IVC filters in preventing pulmonary embolism (PE) in high risk patients undergoing hip or knee arthroplasty. Methods 2,857 hip or knee arthroplasty procedures between January 2013 and December 2018 were retrospectively reviewed. Patients with a pre-operative history of VTE, either PE or DVT, were categorized as high risk patients. The incidence of overall VTE, PE, and DVT were compared between patients with filters and those without. Subgroup analysis was also performed by patient risk and filter status and the incidence of VTE, PE, and DVT were compared. Variables such as filter placement, history of hypercoagulability etc. were evaluated as risk factors for the development of post-operative VTE. Results In the high-risk group, the use of IVC filters was significantly associated with a lower incidence of pulmonary embolism (0.8%vs5.5%,p=0.028). When compared with the low-risk group, the high risk group had significantly higher incidence of PE (3.8%vs2.0%,p=0.038), DVT (11.6% vs 5.3%, p Conclusion The use of IVC filters is significantly associated with a lower incidence in pulmonary embolism in high-risk arthroplasty patients. High risk patients demonstrated an incidence of postoperative VTE over two times greater than other patients. Prophylactic placement of IVC filters in hip/knee arthroplasty is safe.