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Total Joint Arthroplasty in Patients With Atrial Septal Defects: What Are the 90-Day Complications?

Jennifer Bido1, Simarjeet Puri1, Eduardo A Salvati1

  • 1Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.

Arthroplasty Today
|August 29, 2022
PubMed

Insights

Patients with atrial septal defects (ASDs) or patent foramen ovale (PFO) undergoing hip or knee arthroplasty had no embolic events. A cardiology evaluation before surgery is recommended to assess risks and benefits.

Area of Science:

  • Orthopedic Surgery
  • Cardiology
  • Vascular Surgery

Background:

  • Congenital heart defects like atrial septal defects (ASDs) and patent foramen ovale (PFO) may elevate embolic event risk during total hip or knee arthroplasty (THA/TKA).
  • Understanding this risk is crucial for patient management and surgical planning.

Purpose of the Study:

  • To determine the 90-day incidence of embolic events and other complications in patients with ASD/PFO undergoing primary THA/TKA.
  • To evaluate the safety of THA/TKA in patients with known cardiac defects.

Main Methods:

  • Retrospective review of 160 patients (196 primary arthroplasties) with ASD/PFO.
  • Data collected on patient demographics, preoperative anticoagulation, and postoperative complications within 90 days.
  • Follow-up averaged 19 months.

Main Results:

  • No embolic events were identified in the study cohort.
  • Seven percent (14 patients) experienced complications, including bleeding (3%) and other nonoperative issues (8%).
  • Three patients required reoperation for periprosthetic fractures (2) or infection (1).

Conclusions:

  • Primary THA/TKA in patients with ASD/PFO did not result in embolic events in this cohort.
  • Preoperative cardiology evaluation is recommended to assess risks, benefits, and potential defect repair to mitigate embolic event risk.
Abstract

Keywords:
Brain injury after arthroplasty surgeryCerebrovascular accident after orthopedic surgeryPatent foramen ovale (PFO)Stroke after arthroplastyTransient ischemic attack after orthopedic surgery

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