Every day we see patients with varicose veins, and these same individuals are often suffering from osteoarthritis (degenerative joint disease).  This should come as no surprise, since aging is a significant risk factor for both vein and joint disease.  As most people know, wear and tear eventually will weaken bones, joints, and the cartilage in between. Eventually, the pain caused by this degenerative process leads patients to a hip or knee replacement.

Many patients will ask us, “which problem should get treated first, my hip/knee or my veins?”  So, you may ask yourself, does the order really matter? Short answer is yes. Why?  The sequence of treatment may affect your risk for developing a blood clot!  Research has shown that untreated varicose veins are associated with an increased risk of deep venous thrombosis (DVT) after total hip replacement (also known as total hip arthroplasty or THA) or knee replacement (also known as total knee arthroplasty or TKA).  In fact, it has been demonstrated that treating vein disease decreases the chance of post-operative DVT by 50%.

Speaking of knee surgery, we have had the occasional patient with knee pain, thought to be arthritis actually turn out venous disease. For example, a 40-year-old female came to our office with varicose veins in both thighs extending to her lower legs. She had received two negative knee arthroscopes to assess her knee pain. This discomfort was bad enough that she had trouble playing with her young daughters. After we treated her veins, she was thrilled! She could play with her kids again. Also, she had the answer that had eluded her for years. Her knee pain was related to her veins.


Varicose veins are more than a cosmetic concern. Not only do they cause pain, aching, swelling and other lower extremity symptoms but they are a risk factor for blood clots after hip or knee surgery. Thus, it’s useful to receive appropriate vein treatment prior to these orthopedic surgeries.


Prophylactic GSV surgery in elderly candidates for hip or knee arthroplasty

Open Med (Wars). 2016; 11(1): 471–476.  Gennaro Quarto, Bruno Amato, Giacomo Benassai, Marco Apperti, Antonio Sellitti, Luigi Sivero, and Ermenegildo Furino

Does Previous Varicose Vein Surgery Alter Deep Vein Thrombosis Risk after Lower Limb Arthroplasty? Orthopaedic Surgery2012; 4:222–226 • DOI: 10.1111/os.12003

Anahita Dua, MD, Santiago Neiva, Alasdair Sutherland, MD(Hons), FRCSEd(Tr&Orth)