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. 2008 Jul;58(7):1915-20.
doi: 10.1002/art.23607.

Risk factors for cardiovascular complications following total joint replacement surgery

Frederick C Basilico  1 , Gerard Sweeney, Elena Losina, James Gaydos, Debra Skoniecki, Elizabeth A Wright, Jeffrey N Katz
Affiliations

Risk factors for cardiovascular complications following total joint replacement surgery

Frederick C Basilico et al. Arthritis Rheum. 2008 Jul.

Abstract

Objective: To determine risk factors for cardiac complications following total joint replacement (TJR) surgery.

Methods: We performed a case-control study of patients who had undergone a primary or revision total knee or total hip replacement surgery. Cases consisted of those who received a TJR and experienced a cardiac complication during the surgical admission period (myocardial infarction [MI], congestive heart failure [CHF], unstable angina, arrhythmia, symptomatic hypotension, or pulmonary embolus). Controls consisted of those who received a TJR and did not experience a cardiac complication during the surgical admission period. Controls were matched to the cases for age at surgery, year of surgery, and surgeon. Case and control status and identification of potential risk factors were ascertained by review of medical records. Conditional logistic regression analysis was used to identify independent predictors of cardiac complications.

Results: The sample included 209 cases and 209 controls. Factors associated with a higher risk of cardiac complications included a history of arrhythmia (adjusted odds ratio [OR] 2.6 [95% confidence interval (95% CI) 1.5-4.3]), a history of coronary artery disease, MI, CHF, or valvular heart disease (OR 1.6 [95% CI 0.9-2.6]), revision surgery (OR 2.2 [95% CI 1.2-3.9]), and bilateral surgery (adjusted OR 3.5 [95% CI 1.6-8.0]). Even though controls were matched for age (within age brackets), age was still associated with a higher risk of cardiac complications (OR 1.7 [95% CI 0.9-3.4]).

Conclusion: This case-control study identified 2 new risk factors for cardiac complications following TJR: bilateral and revision surgery. The study also confirmed previously documented risk factors, including older age at surgery and a history of arrhythmia and of other cardiac problems. These findings should help clinicians anticipate and prevent cardiac complications following TJR surgery.

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Figures

Figure 1
Figure 1
Flowchart showing the identification of 209 cases of cardiac complications following total joint replacement (TJR) surgery, as well as 209 controls without cardiac complications following TJR surgery who were matched with the cases for age at surgery, surgeon, and year of surgery. TJRs (primary or revision surgery; hip or knee replacement) were performed between November 1, 2001 and March 31, 2004.
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