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Assessment of cardiovascular risk in patients undergoing total joint alloplasty: the CRASH-JOINT study
Paweł Łęgosz, Marcin Kotkowski, Anna E Platek
11st Department of Cardiology, Medical University of Warsaw, Poland. filip.szymanski@wum.edu.pl.
Insights
Patients undergoing total joint replacement have a higher prevalence of cardiovascular risk factors than the general population. This increased prevalence may contribute to a higher risk of perioperative complications in these patients.
Area of Science:
- Orthopaedic Surgery
- Cardiovascular Medicine
- Epidemiology
Background:
- Orthopaedic procedures, particularly total joint alloplasty, carry significant perioperative risks and complication rates.
- Effective risk assessment is crucial for patients undergoing major surgical interventions.
Purpose of the Study:
- To determine the prevalence of cardiovascular risk factors in patients undergoing total hip or knee alloplasty.
- To compare these risk factors against general population data.
Main Methods:
- Prospective, epidemiological study (CRASH-JOINT) involving patients scheduled for total joint replacement.
- Screening for cardiovascular risk factors and ambulatory blood pressure monitoring for hypertension diagnosis.
Main Results:
- 98 patients enrolled; 50 (55.6%) had hypertension, 10 (11.1%) had diabetes, 24 (26.7%) had a family history of cardiovascular disease.
- Higher prevalence of overweight (43.3%) and obesity (31.1%) noted.
- Hip replacement patients were younger, more likely smokers, with lower BMI and less obesity compared to knee replacement patients.
Conclusions:
- Classical cardiovascular risk factors are more prevalent in patients undergoing total hip or knee alloplasty than in the general population.
- This elevated prevalence may increase the risk of perioperative complications.
Background:
Risk assessment is of particular importance for patients undergoing surgical interventions. Orthopaedic procedures, especially total joint alloplasty, are major procedures associated with high perioperative risk, as well as one of the highest rates of complications.
Aim:
The aim of the present study was to establish the prevalence of classical and non-classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty.
Methods:
The CRASH-JOINT (Cardiovascular Risk Assessment ScHeme in JOINT alloplasty) was a prospective, epidemiological study performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for cardiovascular risk factors and had ambulatory blood pressure performed for the diagnosis of hypertension.
Results:
The present study enrolled 98 patients. During initial screening eight patients were disqualified from the study and the surgery, in the majority due to the cardiac causes. Sixty-five patients had a hip joint replacement and 25 had knee joint replacement (mean age 63.7 ± 12.2 years, 62.2% female). Fifty (55.6%) patients were diagnosed with arterial hypertension in the past, ten (11.1%) patients had diabetes mellitus, two (2.2%) had a history of myocardial infarction, and family history of cardiovascular disease was present in 24 (26.7%) cases. Mean body mass index (BMI) was 28.0 ± 5.1 kg/m² and 39 (43.3%) patients were overweight, while 28 (31.1%) were obese. Patients undergoing hip replacement were significantly younger (61.8 ± 12.6 vs. 68.5 ± 10.0 years; p = 0.02), were more often current smokers (24.6% vs. 4.0%; p = 0.03), had significantly lower BMI (26.8 ± 4.5 vs. 31.2 ± 5.3 kg/m²; p < 0.0001), and were less often obese (18.5% vs. 64.0%; p < 0.0001). There were no significant differences between patients scheduled for primary surgery and reoperation.
Conclusions:
The study showed that classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty have a higher prevalent than in the general population, which can potentially contribute to the higher risk of development of perioperative complications.
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