D-dimer shows moderate diagnostic potential for ruling out deep vein thrombosis after total joint arthroplastyD-dimer test helps rule out dangerous blood clots after joint replacement

Deep vein thrombosis (DVT) is a common and serious complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Although plasma D-dimer is widely used to exclude thrombotic events, its diagnostic accuracy in postoperative populations remains controversial due to nonspecific elevation caused by surgical trauma. This meta-analysis aimed to systematically evaluate the diagnostic performance of D-dimer for screening DVT after total joint arthroplasty (TJA). PubMed, Web of Science, Wiley Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP databases were searched from inception to November 2025 for studies that investigated the diagnostic accuracy of D-dimer for detecting DVT after TJA. Study quality was assessed using the QUADAS-2 tool. A bivariate mixed-effects model was applied to pool sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) curves were constructed and the area under the curve (AUC) was calculated using Stata version 14.0. A total of 11 studies involving 7,123 patients were included. The pooled sensitivity and specificity of D-dimer for diagnosing postoperative DVT after TJA were 0.76 (95% CI: 0.64–0.85) and 0.86 (95% CI: 0.55–0.97), respectively. The pooled PLR was 5.24 (95% CI: 1.30–21.08), the NLR was 0.28 (95% CI: 0.16–0.49), and the DOR was 18.59 (95% CI: 2.94–117.42). The AUC of the SROC curve was 0.83 (95% CI: 0.80–0.86). Substantial heterogeneity was observed among studies (I2 > 98%), which was mainly attributable to differences in diagnostic cutoff values. D-dimer demonstrates moderate diagnostic potential for screening DVT after TJA, with its primary value lying in ruling out DVT when results are negative. However, the current pooled estimates do not support a uniform diagnostic threshold or the use of D-dimer as a standalone diagnostic tool. Given the substantial heterogeneity across studies and the variability in specificity due to postoperative physiological elevation, the test should only be considered as part of a risk-stratified screening strategy, ideally in combination with clinical risk assessment models or using procedure- and context-specific cutoff values. Further prospective studies are needed to validate such integrated approaches before clinical implementation.