Incidence and risk factors for postoperative myocardial infarction following hip and knee arthroplasty

Hip and knee arthroplasty are among the most commonly performed surgical procedures worldwide but carry a risk of cardiovascular complications, including myocardial infarction (MI). Therefore, this study aimed to assess the long-term incidence of MI following hip and knee arthroplasty, and subsequent mortality, in a UK-based cohort.

A retrospective cohort study was conducted using linked Hospital Episode Statistics (HES), Office for National Statistics (ONS) mortality data, and Clinical Practice Research Datalink (CPRD) records. Patients undergoing total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) between 2 January 1998 and 29 March 2021 were identified. An inverse probability weighting approach based on propensity scores was used, and outcomes were assessed using weighted logistic regression for MI incidence at 30, 90, and 365 days postoperatively, and multiple Cox proportional hazards models for MI-related mortality.

In total, 1,148,298 procedures were included in the final analysis. Of those undergoing hip arthroplasty, 713 (0.13%) patients experienced a MI within 30 days postoperatively, rising to 947 (0.17%) at 90 days and 1,989 (0.38%) patients at one year. In the knee arthroplasty cohort, the number of patients experiencing a MI was 656 (0.11%) at 30 days, 890 (0.15%) at 90 days, and 1,853 (0.32%) at one year postoperatively. Factors associated with increased MI incidence included age, male sex, non-white ethnicities, geographical region, higher deprivation status, and elevated comorbidity scores. Weighted logistic regression demonstrated significantly lower odds of MI, and MI-related mortality in patients undergoing UKA and HRA compared with TKA and THA, respectively.

In England, post-arthroplasty MI remains uncommon but carries significant mortality risk. Bone-preserving procedures are associated with a significantly reduced incidence of MI and subsequent mortality. These findings emphasize the importance of careful patient and treatment selection, and targeted cardiovascular risk mitigation, to optimize postarthroplasty outcomes.