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

BACKGROUND

Estrogen replacement therapy (ERT) and total joint arthroplasty (TJA) are prevalent in the geriatric population, with limited evidence for how ERT influences postoperative outcomes. ERT is often held before arthroplasty due to the perceived risk for venous thromboembolism (VTE). Our primary aim was to investigate the relationship between ERT and VTE risk and secondarily to investigate major medical complications following TJA.

METHODS

A retrospective review was performed with a large national database querying International Classification of Diseases, tenth revision procedure codes, identifying 893,759 primary total hip arthroplasty (THA) and 1,660,909 total knee arthroplasty (TKA) procedures from 2015 to 2020. Of THAs, a cohort of 3,425 (3.5%) were prescribed ERT within 90 days before surgery and propensity matched to 6,850 control patients for age, tobacco use, obesity, and diabetes diagnosis. Of TKAs, a cohort of 7,409 (3.5%) was prescribed ERT and similarly propensity matched to 14,818 control patients. Propensity-matched data were qualified with adjusted odds ratios (OR) and 95% confidence intervals (CI) for deep vein thrombosis (DVT), pulmonary embolism (PE), and total medical complications.

RESULTS

After propensity matching, ERT use in THA demonstrated decreased risk of DVT (OR 0.52, CI 0.29 to 0.91, P = 0.028) but no difference in PE (OR 0.67, CI 0.34 to 1.32, P = 0.31). The ERT cohort had lower medical complications (OR 0.47, CI 0.31 to 0.73, P < 0.001). Among TKAs, ERT use was associated with decreased risk of DVT (OR 0.60, CI 0.44 to 0.82, P = 0.001), PE (OR 0.56, CI 0.37 to 0.83, P = 0.005), and medical complications (OR 0.53, CI 0.42 to 0.67, P < 0.001).

CONCLUSIONS

The use of ERT with TJA is associated with decreased risk of VTE and major medical postoperative complications. These findings should be considered when counseling patients regarding the management of ERT when undergoing TJA.