ArticleResearch and practice in thrombosis and haemostasis2026
Prior intra-articular sodium hyaluronate injection as a novel predictor of isolated distal deep vein thrombosis after knee surgery: development and validation of a 5-factor nomogram.
Article in Research and practice in thrombosis and haemostasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Isolated distal deep vein thrombosis (IDDVT) is a frequent but underrecognized complication after knee surgery. Existing prediction tools rarely target distal thrombosis specifically and often omit key perioperative laboratory, inflammatory, and procedural variables. Objectives: The study's objective was to pinpoint independent determinants of postoperative IDDVT and to design a personalized predictive nomogram. Methods: This retrospective analysis enrolled 1068 individuals who received knee operations during the period from 2019 to 2024. Demographic characteristics, laboratory biomarkers, inflammatory indices, anesthesia duration, and a history of intra-articular sodium hyaluronate injection were collected. Least absolute shrinkage and selection operator regression identified the relevant predictors, which were then input into a multivariable logistic regression model to produce the final algorithm. Model performance was evaluated through area under the curve (AUC) analysis, bootstrap-based calibration assessment, decision curve analysis, and examination of clinical impact curve. Results: IDDVT occurred in 84 patients (7.9%). Five variables were independently associated with IDDVT: D-dimer, fasting plasma glucose, neutrophil-to-lymphocyte ratio, anesthesia duration, and prior intra-articular sodium hyaluronate injection. The nomogram demonstrated excellent discrimination (area under the curve, 0.889; 95% CI, 0.851-0.927) and good calibration (Brier score, 0.052; calibration slope, 1.000). Both decision curve analysis and clinical impact curve demonstrated that the model offered substantial net benefit across threshold probabilities ranging from 1% to 74%. Conclusion: We developed and validated a 5-factor nomogram for predicting post-knee surgery IDDVT. Prior sodium hyaluronate injection emerged as a significant predictor, likely as a marker of advanced joint pathology. Further prospective studies are needed to integrate this finding into perioperative risk management.
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