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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Adverse cardiac events associated with primary and revision arthroplasty

Christian Puelacher1,2, Adrian Stuetzle3, Mario Morgenstern3,4

  • 1Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.

The Bone & Joint Journal
|August 1, 2025
PubMed

Insights

Revision surgery for periprosthetic joint infection (PJI) significantly increases risks of perioperative myocardial injury and infarction (PMI), major adverse cardiac events (MACE), and mortality compared to primary arthroplasty.

Area of Science:

  • Orthopedic Surgery
  • Cardiology
  • Infectious Disease

Background:

  • Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
  • Revision surgery for PJI carries significant risks, but the specific impact on perioperative cardiac outcomes requires detailed analysis.

Purpose of the Study:

  • To compare the risks of perioperative myocardial injury and infarction (PMI), major adverse cardiac events (MACE), and mortality between revision for PJI, aseptic revision, and primary arthroplasty.
  • To identify specific cardiovascular risks associated with revision arthroplasty, particularly in the context of PJI.

Main Methods:

  • Post-hoc analysis of the BASEL-PMI study including 673 patients undergoing primary or revision total hip/knee arthroplasty.
  • Measurement of high-sensitivity cardiac troponin T preoperatively and postoperatively.
  • Assessment of PMI, all-cause mortality, and MACE at 120 days.

Main Results:

  • Higher rates of PMI were observed in revision for PJI (35%) and aseptic revision (21%) compared to primary arthroplasty (12%).
  • All-cause mortality was significantly increased in revision for PJI (9%) versus aseptic revision (4%) and primary arthroplasty (2%).
  • Revision for PJI also showed increased MACE rates (12%) and a 2.9-fold increased odds of PMI.

Conclusions:

  • Revision arthroplasty, especially for PJI, is associated with significantly higher risks of perioperative cardiac complications and mortality.
  • Cardiovascular risk stratification and management are crucial for patients undergoing revision arthroplasty, particularly those with PJI.
Abstract

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