Systematic Review and Meta-Analysis of Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty with Pre-Existing Varicose Veins

Objective: A systematic review and meta-analysis was performed to determine whether patients with varicose veins requiring lower limb arthroplasty should have their veins surgically treated first to decrease the risk of venous thromboembolism (VTE). Methods: Medline, Embase, and Cochrane Library databases were searched using appropriate terms for all studies reporting on VTE in patients undergoing lower limb arthroplasty who had pre-existing varicose veins. Methodological quality of included studies was quantified using the Downs and Black checklist. The systematic review was conducted according to PRISMA guidelines. Results: A total of 129 studies were identified, with 11 being eligible for inclusion. The studies included 265 194 patients who underwent lower limb arthroplasty, 2 188 of whom had pre-existing varicose veins. Overall, VTE occurred in 1 807 patients, and 108 of these had varicose veins present at the time of arthroplasty. Meta-analysis indicates that patients undergoing lower limb arthroplasty with varicose veins are at increased risk of having a VTE (RR 1.76, 95% CI 1.13 2.73, p = .012). Only one study evaluated the incidence of VTE in patients with prior varicose vein surgery. Conclusion: Varicose veins and lower limb arthroplasty are known independent risk factors for VTE. There is a paucity of available data on this topic; however, this study shows that patients with varicose veins are at an increased risk of VTE when undergoing major lower limb arthroplasty. Only one study indicated that patients might benefit from varicose vein surgery before major joint replacement, and further studies are necessary to validate these findings.