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Observational Study
. 2025 Aug 1;107-B(8):821-828.
doi: 10.1302/0301-620X.107B8.BJJ-2025-0048.R1.

Adverse cardiac events associated with primary and revision arthroplasty

Christian Puelacher  1   2 , Adrian Stuetzle  3 , Mario Morgenstern  3   4 , Parham Sendi  3   5 , Christian Mueller  1 , Martin Clauss  3   4 ; BASEL-Ortho-PMI Investigators
Collaborators, Affiliations
Observational Study

Adverse cardiac events associated with primary and revision arthroplasty

Christian Puelacher et al. Bone Joint J. .

Abstract

Aims: The aim of this study was to analyze the risk of perioperative adverse outcomes, including perioperative myocardial injury and infarction (PMI), major adverse cardiac events (MACE), and mortality, which are associated with revision for periprosthetic joint infection (PJI) compared with primary arthroplasty and aseptic revision surgery.

Methods: This was a post-hoc analysis of the BASEL-PMI study (NCT02573532). The study included patients from one tertiary care centre who underwent primary total hip (THA) or knee (TKA) arthroplasty, and revision THA and TKA. Patients were included if they had established cardiovascular comorbidities or were aged ≥ 65 years, and were eligible for our institutional PMI screening and response programme. High-sensitivity cardiac troponin T levels were measured preoperatively and on postoperative days one and two. The primary endpoint was the incidence of PMI, and secondary endpoints included the rates of all-cause mortality and MACE at 120 days postoperatively.

Results: Between May 2014 and February 2018, 673 patients were included in the study, of whom 443 underwent primary THA or TKA, 111 underwent aseptic revision, and 119 underwent revision for PJI. PMI occurred in 120 patients (18%) overall, with higher rates in revisions (23; 21%) in the aseptic and 42 (35%) in the PJI groups) compared with 55 (12%) in the primary arthroplasty group. All-cause mortality was significantly increased in patients who underwent revision for PJI (9%) compared with aseptic revision (4%) and primary arthroplasty (2%). The rates of MACE were also increased in revisions, particularly in those for PJI (12%). Multivariable analysis showed an odds ratio of 2.9 (95% CI 1.7 to 5.2) for PMI in revisions for PJI.

Conclusion: Patients who underwent revision arthroplasty had significantly increased risks of PMI, MACE, and mortality compared with those who underwent primary arthroplasty. In revision surgery, revision for PJI showed an especially high risk of cardiovascular complications.

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Conflict of interest statement

C. Puelacher reports grants from Roche Diagnostics, the Swiss Heart Foundation, and the University Hospital Basel dedicated to conduct of this study, as well as chairing an advisory board for Roche Diagnostics during the conduct of the study. C. Puelacher also reports institutional consulting fees (paid to University of Basel) from Roche Diagnostics, not related to this study. C. Müller reports grants from the Swiss Heart Foundation, the Swiss National Science Foundation, the University of Basel, the University Hospital Basel, and Roche Diagnostics, as well as grants and non-financial support from several diagnostic companies during the conduct of the study. C. Müller also reports grants, personal fees, and non-financial support from several diagnostic companies outside the submitted work.

References

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