619 - The Use of Inferior Vena Cava Filters in High Risk Patients Undergoing Total Joint Arthroplasty

Purpose: The inferior vena cava filter (IVCF) has been utilized to reduce the risk of pulmonary embolism (PE) in individuals at high risk for venous thromboembolism (VTE) and deep-vein thrombosis (DVT) with contraindications to pharmacologic prophylaxis. Patients undergoing total joint arthroplasty (TJA) are at an increased risk of thromboembolic events, and the consideration of IVCF has not been fully explored in this subset of patients.

Materials and Methods: TriNetX was used to evaluate patient electronic medical records between January 1st, 2016 and December 1st, 2024. Patients were identified who had undergone a first-time total hip (THA) or total knee (TKA) arthroplasty. Patients were then divided into two groups based on IVCF status (TKA/THA-IVCF vs TKA/THA-only). Patients considered “high-risk”, or had a previous history of PE, DVT, or personal history of hypercoagulable state were solely included and 1-to-1 propensity matched. Final cohorts for the TKA groups with and without IVCF were 135. Final cohorts for the THA groups with and without IVCF were 159. Primary outcomes measured were the rates of DVT and PE at 1, 3, and 6 months. Secondary outcome measured was the rate of IVCF retrieval at 6 months.

Results: TKA-IVCF was associated with slightly higher rates of DVT at one (RR = 2.1, 95% CI (1.028,4.29)), three (RR = 2.1, 95% CI (1.305,3.38)), and six months (RR = 1.923, 95% CI (1.277,2.896)) compared to TKA-only. Similarly, THA-IVCF was associated with significantly higher rates of DVT at one (RR = 4.636, 95% CI (2.511,8.562)), three (RR = 3.2, 95% CI (2.163,4.734)), and six months (RR = 3.148, 95% CI (2.168,4.572)) than THA-only. TKA-IVCF (RR = 1.824, 95% CI (1.061,3.133)) and THA-IVCF (RR = 2.133, 95% CI (1.203,3.782)) were associated with slightly more PEs at six months, respectively, than their non-IVCF counterparts. At 6 months, 79 filters (58.5%) from TKA-IVCF and 95 filters (59.7%) from THA-IVCF were retrieved. No significant difference in filter retrieval was found between both groups.

Conclusion: IVCF are effective at preventing PE formation in patients undergoing TJA. While later endpoints may indicate that these IVCF fail in doing so, greater filter retrievals at these times predispose those patients to higher rates of PE formation. Further randomized-control trials are necessary to ascertain IVCF efficacy in this patient subset.