Incidence and risk factor analysis for preoperative deep vein thrombosis in patients with periprosthetic hip fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Dengxian ^1,2,3 , YAO Yao ^1,2,3 , QIAO Liang ^1,2,3 , XU Zhihong ^1,2,3 , CHEN Dongyang ^1,2,3 , WANG Weijun ^1,2,3 ,  QIU Junlan ⁴ ,  JIANG Qing ^1,2,3

1. Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing Jiangsu, 210008, P. R. China;
2. Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China;
3. Jiangsu Key Laboratory of Molecular Medicine, Nanjing Jiangsu, 210008, P. R. China;
4. Department of Medical Ultrasound, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;

Corresponding?author：

QIU Junlan, Email: weiyumo@163.com; JIANG Qing, Email: qingj@nju.edu.cn

Keywords：

Periprosthetic hip fracture; deep vein thrombosis; risk factor; coronary atherosclerotic heart disease; D-dimer

DOI：

10.7507/1002-1892.202601139

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Objective To investigate the incidence and risk factors of preoperative deep vein thrombosis (DVT) in patients with periprosthetic hip fractures. Methods This retrospective clinical cohort study enrolled 95 patients with periprosthetic hip fractures who met predefined inclusion and exclusion criteria between January 2016 and December 2025. The cohort included 28 males and 67 females, with a mean age of 72.9 years (range, 39-96 years). According to Vancouver classification, there were 1 case of type A, 32 cases of type B1, 59 cases of type B2, 1 case of type B3, and 2 cases of type C. The interval from injury to hospital admission ranged from 1 to 150 days (mean, 10.9 days). All patients received bilateral lower-extremity venous ultrasonography for preoperative DVT screening. Patients were divided into DVT-positive and DVT-negative groups according to ultrasound findings. Univariate analyses were conducted to compare demographic data (age, gender), underlying comorbidities (hypertension, diabetes mellitus, coronary atherosclerotic heart disease, cerebral infarction, etc.), Vancouver fracture type, injury-to-admission interval, and laboratory indicators (prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, D-dimer, fibrinogen, hemoglobin, red blood cell count, hematocrit, platelet count, serum albumin, triglycerides, total cholesterol, apolipoprotein, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) between the two groups. The risk factors of preoperative DVT in periprosthetic hip fractures were further screened by logistic regression analysis. Results The overall preoperative prevalence of DVT was 28.42% (27/95) among patients with periprosthetic hip fractures. Subgroup analysis stratified by thrombus location showed 1 case (1.05%) of proximal DVT, 2 cases (2.11%) of distal axial DVT, and 24 cases (25.26%) of calf muscular vein thrombosis. Univariate analysis revealed significant intergroup differences in the prevalence of history of coronary atherosclerotic heart disease and preoperative D-dimer levels between DVT-positive and DVT-negative groups (P<0.05). Receiver operating characteristic curve analysis was performed to assess the predictive efficacy of preoperative D-dimer for preoperative DVT. The area under the curve was 0.667 (95%CI: 0.545, 0.772) (P=0.016). The optimal D-dimer cutoff value was 5.26 mg/L, with a sensitivity of 0.667 and specificity of 0.618. Stratified analysis based on this cutoff demonstrated that patients with D-dimer≥5.26 mg/L had a markedly higher incidence of DVT than those with D-dimer<5.26 mg/L [40.91% (18/44) vs. 17.65% (9/51); χ²=6.283, P=0.012]. logistic regression analysis further verified that history of coronary atherosclerotic heart disease and preoperative D-dimer≥5.26 mg/L were independent risk factors for preoperative DVT (P<0.05). Conclusion The incidence of preoperative DVT is considerably high in patients with periprosthetic hip fractures. History of coronary atherosclerotic heart disease and elevated preoperative D-dimer (≥5.26 mg/L) are independent risk factors for preoperative DVT in patients with periprosthetic hip fractures, which should be paid great attention to clinically.

Citation： WU Dengxian, YAO Yao, QIAO Liang, XU Zhihong, CHEN Dongyang, WANG Weijun, QIU Junlan, JIANG Qing. Incidence and risk factor analysis for preoperative deep vein thrombosis in patients with periprosthetic hip fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(7): 1055-1060. doi: 10.7507/1002-1892.202601139 Copy

1.	Wu KA, Dilbone ES, Kugelman DN, et al. The impact of total hip arthroplasty on daily ambulatory function: A prospective study. J Arthroplasty, 2025, 40(9S1): S253-S258.
2.	Pentland V, Thompson Z, Dayimu A, et al. Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet, 2026, 407(10531): 855-866.
3.	Khan F, Tritschler T, Kahn SR, et al. Venous thromboembolism. Lancet, 2021, 398(10294): 64-77.
4.	Simon SJ, Patell R, Zwicker JI, et al. Venous thromboembolism in total hip and total knee arthroplasty. JAMA Netw Open, 2023, 6(12): e2345883. doi: 10.1001/jamanetworkopen.2023.45883.
5.	Konow T, Baetz J, Melsheimer O, et al. Factors influencing periprosthetic femoral fracture risk. Bone Joint J, 2021, 103-B(4): 650-658.
6.	Bottle A, Griffiths R, White S, et al. Periprosthetic fractures: the next fragility fracture epidemic? A national observational study. BMJ Open, 2020, 10(12): e042371. doi: 10.1136/bmjopen-2020-042371.
7.	Xia ZN, Xiao K, Zhu W, et al. Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture. J Orthop Surg Res, 2018, 13(1): 291. doi: 10.1186/s13018-018-0998-4.
8.	Dou C, Li T, Yang S, et al. Epidemiological status and risk factors of deep vein thrombosis in patients with femoral neck fracture. J Orthop Surg Res, 2022, 17(1): 41. doi: 10.1186/s13018-022-02926-8.
9.	Qiao L, Wu D, Shen Y, et al. The safety of patients who have preoperative venous thromboembolism undergoing joint arthroplasty. J Arthroplasty, 2026, 41(4): 1041-1047.
10.	Fu YH, Liu P, Xu X, et al. Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499019901172. doi: 10.1177/2309499019901172.
11.	喬梁, 姚堯, 吳登先, 等. 貧血對人工全髖關節置換術患者圍術期下肢深靜脈血栓形成的影響. 中國修復重建外科雜志, 2024, 38(5): 570-575.
12.	沈穎, 姚堯, 喬梁, 等. 人工全髖關節置換術翻修術患者Barthel指數評分與術前下肢深靜脈血栓形成發生的相關性分析. 中國修復重建外科雜志, 2025, 39(2): 158-162.
13.	Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J, 2020, 41(3): 407-477.
14.	Wang T, Guo J, Long Y, et al. Risk factors for preoperative deep venous thrombosis in hip fracture patients: a meta-analysis. J Orthop Traumatol, 2022, 23(1): 19. doi: 10.1186/s10195-022-00639-6.
15.	Zhang BF, Wei X, Huang H, et al. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging, 2018, 13: 681-689.
16.	Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-Dimer. J Am Coll Cardiol, 2017, 70(19): 2411-2420.
17.	Wang T, Yin H, Li C, et al. Establishment and validation of a predictive nomogram for preoperative deep vein thrombosis in elderly patients with isolated femoral neck fracture. Sci Rep, 2025, 15(1): 22601. doi: 10.1038/s41598-025-06305-1.
18.	Li Y, Cao P, Zhu T, et al. Combination of age-adjusted d-dimer, platelet distribution width and other factors predict preoperative deep venous thrombosis in elderly patients with femoral neck fracture. BMC Surg, 2024, 24(1): 426. doi: 10.1186/s12893-024-02724-5.
19.	王永剛, 付凱, 鄭偉, 等. 老年股骨頸骨折圍術期下肢深靜脈血栓形成危險因素分析. 中國修復重建外科雜志, 2024, 38(11): 1336-1339.
20.	Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264. doi: 10.1186/s12891-021-04145-4.

1. Wu KA, Dilbone ES, Kugelman DN, et al. The impact of total hip arthroplasty on daily ambulatory function: A prospective study. J Arthroplasty, 2025, 40(9S1): S253-S258.
2. Pentland V, Thompson Z, Dayimu A, et al. Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet, 2026, 407(10531): 855-866.
3. Khan F, Tritschler T, Kahn SR, et al. Venous thromboembolism. Lancet, 2021, 398(10294): 64-77.
4. Simon SJ, Patell R, Zwicker JI, et al. Venous thromboembolism in total hip and total knee arthroplasty. JAMA Netw Open, 2023, 6(12): e2345883. doi: 10.1001/jamanetworkopen.2023.45883.
5. Konow T, Baetz J, Melsheimer O, et al. Factors influencing periprosthetic femoral fracture risk. Bone Joint J, 2021, 103-B(4): 650-658.
6. Bottle A, Griffiths R, White S, et al. Periprosthetic fractures: the next fragility fracture epidemic? A national observational study. BMJ Open, 2020, 10(12): e042371. doi: 10.1136/bmjopen-2020-042371.
7. Xia ZN, Xiao K, Zhu W, et al. Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture. J Orthop Surg Res, 2018, 13(1): 291. doi: 10.1186/s13018-018-0998-4.
8. Dou C, Li T, Yang S, et al. Epidemiological status and risk factors of deep vein thrombosis in patients with femoral neck fracture. J Orthop Surg Res, 2022, 17(1): 41. doi: 10.1186/s13018-022-02926-8.
9. Qiao L, Wu D, Shen Y, et al. The safety of patients who have preoperative venous thromboembolism undergoing joint arthroplasty. J Arthroplasty, 2026, 41(4): 1041-1047.
10. Fu YH, Liu P, Xu X, et al. Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499019901172. doi: 10.1177/2309499019901172.
11. 喬梁, 姚堯, 吳登先, 等. 貧血對人工全髖關節置換術患者圍術期下肢深靜脈血栓形成的影響. 中國修復重建外科雜志, 2024, 38(5): 570-575.
12. 沈穎, 姚堯, 喬梁, 等. 人工全髖關節置換術翻修術患者Barthel指數評分與術前下肢深靜脈血栓形成發生的相關性分析. 中國修復重建外科雜志, 2025, 39(2): 158-162.
13. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J, 2020, 41(3): 407-477.
14. Wang T, Guo J, Long Y, et al. Risk factors for preoperative deep venous thrombosis in hip fracture patients: a meta-analysis. J Orthop Traumatol, 2022, 23(1): 19. doi: 10.1186/s10195-022-00639-6.
15. Zhang BF, Wei X, Huang H, et al. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging, 2018, 13: 681-689.
16. Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-Dimer. J Am Coll Cardiol, 2017, 70(19): 2411-2420.
17. Wang T, Yin H, Li C, et al. Establishment and validation of a predictive nomogram for preoperative deep vein thrombosis in elderly patients with isolated femoral neck fracture. Sci Rep, 2025, 15(1): 22601. doi: 10.1038/s41598-025-06305-1.
18. Li Y, Cao P, Zhu T, et al. Combination of age-adjusted d-dimer, platelet distribution width and other factors predict preoperative deep venous thrombosis in elderly patients with femoral neck fracture. BMC Surg, 2024, 24(1): 426. doi: 10.1186/s12893-024-02724-5.
19. 王永剛, 付凱, 鄭偉, 等. 老年股骨頸骨折圍術期下肢深靜脈血栓形成危險因素分析. 中國修復重建外科雜志, 2024, 38(11): 1336-1339.
20. Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264. doi: 10.1186/s12891-021-04145-4.

Chinese Journal of Reparative and Reconstructive Surgery

Incidence and risk factor analysis for preoperative deep vein thrombosis in patients with periprosthetic hip fractures

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