More Steps After TKA Linked to Lower VTE Risk | Orthopedics Today

The immediate postoperative period following total knee arthroplasty (TKA) presents a critical window for preventing venous thromboembolism (VTE), a potentially life-threatening complication involving blood clots. Emerging research suggests a strong link between higher activity levels soon after surgery and a reduced risk of developing VTE. A study presented at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in March 2026 indicated that patients who took more steps in the weeks following TKA were significantly less likely to experience VTE compared to those with lower activity levels.

Activity as a Modifiable Risk Factor

Venous thromboembolism, encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a significant concern after major orthopedic surgeries like TKA. Traditionally, preventative measures have focused on pharmacological interventions, such as blood thinners. However, the new findings highlight the potential for optimizing patient recovery through encouraging and monitoring physical activity. “Activity has become a modifiable risk factor due to the fact that we can measure it,” explained Michele R. D’Apuzzo, MD, of the University of Miami, who led the research. “Now we can prevent patients who are getting into that risk factor to be able to modify and avoid this complication.”

The study retrospectively analyzed insurance claims data from 617 patients (653 TKAs) who received a smart implantable device during their TKA procedure between October 2021 and November 2024. Researchers compared cumulative step counts at weeks 2, 4, 8, and 12 post-surgery between patients who did and did not develop VTE. The analysis revealed that lower cumulative step counts were associated with significantly higher rates of VTE at weeks 4, 8, and 12. Specifically, patients in the lower step count group were 2.6 times more likely to develop VTE than those in the higher step count group. The risk for VTE between day 14 and 90 was 7.4% in the lower step count group versus 2.9% in the higher step count group.

Understanding Venous Thromboembolism

VTE occurs when a blood clot forms in a deep vein, most often in the legs (DVT). If this clot breaks loose and travels to the lungs, it can cause a pulmonary embolism (PE), a potentially fatal condition. Symptoms of DVT can include pain, swelling, redness, and warmth in the affected leg. PE symptoms include shortness of breath, chest pain, coughing, and rapid heartbeat. The Centers for Disease Control and Prevention (CDC) provides comprehensive information on VTE, including risk factors, symptoms, and prevention strategies.

Study Details and Limitations

The research presented at the AAOS meeting utilized a retrospective analysis of insurance claims data, which inherently carries certain limitations. Retrospective studies can identify associations but cannot definitively prove cause-and-effect relationships. It’s possible that other factors, not accounted for in the analysis, contributed to the observed differences in VTE rates. For example, patients with lower step counts may have had pre-existing conditions or other complications that increased their risk of VTE. The study also relied on data from patients who received a smart implantable device, which may not be representative of the broader TKA population.

the study did not investigate the optimal level of activity required to minimize VTE risk. It simply demonstrated an association between higher step counts and lower VTE rates. Future research is needed to determine the specific activity thresholds that provide the greatest benefit. The researchers acknowledge that the study’s findings are preliminary and require further validation through prospective clinical trials.

Implications for Patient Care

Despite the limitations, the study’s findings have important implications for patient care following TKA. The results suggest that encouraging early and consistent activity may be a valuable strategy for reducing VTE risk. Healthcare providers can utilize wearable activity trackers or other monitoring devices to assess patients’ activity levels and provide personalized recommendations.

However, it’s crucial to emphasize that activity should be tailored to each patient’s individual capabilities and tolerance. Overexertion can lead to pain, swelling, and other complications. A gradual and progressive increase in activity is generally recommended, guided by a physical therapist or other qualified healthcare professional. The American Academy of Orthopaedic Surgeons offers resources for patients undergoing joint replacement surgery, including information on rehabilitation and recovery.

The Role of Technology in Postoperative Monitoring

Dr. D’Apuzzo’s team plans to conduct further analysis of the data to identify other potential complications that can be avoided through 24-hour at-home patient monitoring. The use of smart implantable devices and wearable sensors is becoming increasingly common in orthopedic surgery, allowing for remote monitoring of patients’ activity levels, range of motion, and other key parameters. This technology has the potential to revolutionize postoperative care, enabling earlier detection of complications and more personalized treatment plans.

What’s Next: Expanding the Research

The research team intends to explore the potential of using continuous activity monitoring to identify patients at high risk for VTE and other postoperative complications. They also plan to investigate the impact of different rehabilitation protocols on VTE rates. Further studies are needed to determine the long-term effects of increased activity on patient outcomes following TKA. The findings from this research may also inform the development of new clinical guidelines for VTE prevention in patients undergoing TKA. Healio provides ongoing coverage of advancements in orthopedic surgery and related fields.

For more information, Michele R. D’Apuzzo, MD, can be contacted at [email protected].