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Myocardial Infarction Within One Year of Total Hip Arthroplasty Increases Medical Complications in a Time-Dependent

Alejandro M Holle1, Sayi P Boddu1, Jens T Verhey2

  • 1Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.

The Journal of Arthroplasty
|July 3, 2025
PubMed

Insights

A recent myocardial infarction (MI) within six months before total hip arthroplasty (THA) significantly increases the risk of postoperative complications, including heart failure and mortality. Specific MI types and treatments further elevate these risks.

Area of Science:

  • Cardiology
  • Orthopedic Surgery
  • Health Services Research

Background:

  • Myocardial infarction (MI) is a critical comorbidity impacting surgical outcomes.
  • Understanding the perioperative risks associated with prior MI before total hip arthroplasty (THA) is essential for patient management.

Purpose of the Study:

  • To investigate the influence of the timing, type, and treatment of myocardial infarction (MI) preceding total hip arthroplasty (THA) on postoperative cardiac and general medical complications.

Main Methods:

  • A retrospective analysis of a national administrative claims database was performed.
  • Patients undergoing primary THA were identified and matched with controls.
  • MI patients were stratified by the timing of their MI before THA (0-6, 6-12, 12-18, 18-24 months).

Main Results:

  • A history of MI significantly increased the risk of postoperative MI (OR: 4.06), heart failure (OR: 1.65), and 90-day mortality (OR: 2.22).
  • The highest risk of postoperative MI was observed within 6 months of THA, especially for type 1 MI (OR: 8.07) and percutaneous coronary intervention (PCI)-treated MI (OR: 14.09).
  • ST-segment elevation myocardial infarctions (STEMIs) were associated with increased 90-day mortality (OR: 2.69), and inferior infarcts were linked to higher risks of postoperative MI and mortality.

Conclusions:

  • Myocardial infarction occurring within six months prior to THA, particularly type 1 MI, STEMI, PCI-treated MI, and inferior MI, poses the greatest risk for adverse postoperative outcomes.
  • These findings highlight the importance of considering MI timing, type, and treatment when assessing surgical risk for THA patients.
Abstract

Keywords:
myocardial infarctionpostoperative complicationspreoperative optimizationrisk stratificationtotal hip arthroplasty

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