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Long-Term Risk of Heart Failure in Total Joint Arthroplasty: A Population-Based Cohort Study
Mingzhao Hu1, Lindsey E Turner2, Joshua P Slusser1
1Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
The Journal of Arthroplasty
|May 21, 2025
Summary
Total joint arthroplasty (TJA) patients face an increased heart failure risk beyond ten years post-surgery. This risk, though small, is higher for hip and knee replacement recipients, particularly those with specific implants.
Area of Science:
- Orthopedic Surgery
- Cardiovascular Health
- Biomaterials Science
Background:
- Concerns exist regarding cardiovascular effects of metal debris from total joint arthroplasty (TJA) implants.
- Previous case reports highlighted potential risks, necessitating long-term outcome studies.
Purpose of the Study:
- To compare the long-term risk of heart failure in individuals who underwent TJA versus a general population cohort.
- To investigate the temporal relationship between TJA and incident heart failure.
Main Methods:
- Population-based, retrospective cohort study involving 7,182 TJA (hip and knee) and 7,407 matched non-TJA subjects.
- Follow-up until death, heart failure diagnosis, or 2020, with data collected on surgical history and cardiovascular risk factors.
- Poisson regression models used to estimate heart failure risk, accounting for competing risks and adjusting for covariates.
Main Results:
- TJA subjects had a higher prevalence of cardiovascular risk factors at baseline.
- Heart failure risk was similar in the first decade post-TJA but increased significantly in the second decade.
- Increased risk observed for both total hip arthroplasty (THA) and total knee arthroplasty (TKA), with higher risk in THA patients with cobalt-chromium implants.
Conclusions:
- A higher risk of heart failure is evident beyond the first decade following TJA.
- The absolute risk increase is small and warrants cautious interpretation due to potential biases.
- Long-term cardiovascular monitoring may be considered for TJA patients, especially those with specific implant types or indications.
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