Current evidence does not provide clear guidance about whether inferior vena cava (IVC) filters prevent pulmonary embolism in patients undergoing elective hip and knee arthroplasty who also have a contraindication to chemoprophylaxis and/or known residual venous thromboembolic disease. Therefore, we are unable to recommend for or against the use of such filters.

Rationale
No studies met the inclusion criteria for VTED-related outcomes in arthroplasty patients. Two studies of non-arthroplasty patients compared PE and death rates between patients who received IVC filters and those who did not (see Table 45 for a summary of the results of these studies, Table 46 for a detailed presentation of the results of these studies, and Table 56 in Appendix XIII for our evaluations of their quality and applicability). One was a low quality study of bariatric surgery patients, which found no differences in VTED outcomes between patients with and without IVC filters. The other was a low quality study of trauma patients which reported lower rates of PE and fatal PE in patients who received IVC filters. The work group did not make a consensus recommendation for or against the use of inferior vena cava filters because these filters require surgery to place in the patient. Surgery adds cost and potential harms to the patient, and consensus recommendations are only allowed for low cost and low risk interventions. Therefore, based on the limited and conflicting data regarding the benefits of IVC filters in preventing pulmonary embolism, and the fact that none of the studies included arthroplasty patients, we are unable to recommend for or against their use in hip and knee arthroplasty patients (the reasons we excluded some studies that were initially considered for this recommendation are provided in Appendix XIV, Table 65).
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