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Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty

Jasvinder A Singh1, Matthew R Jensen, William Scott Harmsen

  • 1Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Jasvinder.md@gmail.com

Annals of the Rheumatic Diseases
|October 25, 2011
PubMed

Insights

Complications after total hip or knee replacement are linked to older age, higher comorbidity, and prior cardiac or thromboembolic disease. These factors increase the risk of cardiac events and blood clots within 90 days post-surgery.

Area of Science:

  • Orthopedic Surgery
  • Cardiovascular Medicine
  • Thromboembolic Disease Research

Background:

  • Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures for joint degeneration.
  • Post-operative complications, including cardiac and thromboembolic events, can significantly impact patient outcomes.
  • Identifying predictors of these complications is crucial for risk stratification and management.

Purpose of the Study:

  • To investigate the incidence and predictors of 90-day complications following THA and TKA.
  • To assess the occurrence of cardiac complications (myocardial infarction, arrhythmia, heart failure) and thromboembolic complications (DVT, PE) within 90 days.
  • To identify patient-specific factors associated with an increased risk of these adverse events.

Main Methods:

  • A population-based cohort study of Olmsted County residents who underwent THA or TKA between 1994 and 2008.
  • Assessment of 90-day occurrence of cardiac complications, thromboembolic complications, and mortality.
  • Multivariable-adjusted logistic regression analyses were employed to identify significant predictors.

Main Results:

  • 90-day complication rates were: cardiac (6.9% THA, 6.7% TKA), thromboembolic (4.0% THA, 4.9% TKA), and mortality (0.7% THA, 0.4% TKA).
  • Predictors for cardiac complications post-THA included higher ASA class and Deyo-Charlson comorbidity score in patients without prior cardiac events.
  • For TKA patients, older age (>65) and higher ASA class were associated with cardiac events, while higher Charlson index predicted thromboembolic events.

Conclusions:

  • Older age, elevated comorbidity scores, higher American Society of Anesthesiologists (ASA) class, and a history of cardiac or thromboembolic disease are significant risk factors.
  • These factors are associated with an increased likelihood of 90-day cardiac and thromboembolic complications after THA and TKA.
  • Risk stratification using these parameters can aid in optimizing patient care and reducing post-operative adverse events.
Abstract

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