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Postoperative Myocardial Infarction and Cardiac Arrest Following Primary Total Knee and Hip Arthroplasty: Rates, Risk Factors, and Time of Occurrence

Belmont, Philip J. Jr. MD; Goodman, Gens P. DO; Kusnezov, Nicholas A. MD; Magee, Charles MD, MPH; Bader, Julia O. PhD; Waterman, Brian R. MD; Schoenfeld, Andrew J. MD, MSc

Journal of Bone & Joint Surgery - American Volume: 17 December 2014 - Volume 96 - Issue 24 - p 2025–2031
doi: 10.2106/JBJS.N.00153
Scientific Articles
Supplementary Content

Background: Cardiac complications are a major cause of postoperative morbidity. The purpose of this study was to determine the rates, risk factors, and time of occurrence for cardiac complications within thirty days after primary unilateral total knee arthroplasty and total hip arthroplasty.

Methods: The American College of Surgeons National Surgical Quality Improvement Program data set from 2006 to 2011 was used to identify all total knee arthroplasties and total hip arthroplasties. Cardiac complications occurring within thirty days after surgery were the primary outcome measure. Patients were designated as having a history of cardiac disease if they had a new diagnosis or exacerbation of chronic congestive heart failure or a history of angina within thirty days before surgery, a history of myocardial infarction within six months, and/or any percutaneous cardiac intervention or other major cardiac surgery at any time. An analysis of the occurrence of all major cardiac complications and deaths within the thirty-day postoperative time frame was performed.

Results: For the 46,322 patients managed with total knee arthroplasty or total hip arthroplasty, the cardiac complication rate was 0.33% (n = 153) at thirty days postoperatively. In both the total knee arthroplasty and total hip arthroplasty groups, an age of eighty years or more (odds ratios [ORs] = 27.95 and 3.72), hypertension requiring medication (ORs = 4.74 and 2.59), and a history of cardiac disease (ORs = 4.46 and 2.80) were the three most significant predictors for the development of postoperative cardiac complications. Of the patients with a cardiac complication, the time of occurrence was within seven days after surgery for 79% (129 of the 164 patients for whom the time of occurrence could be determined).

Conclusions: An age of eighty years or more, a history of cardiac disease, and hypertension requiring medication are significant risk factors for developing postoperative cardiac complications following primary unilateral total knee arthroplasty and total hip arthroplasty. Consideration should be given to a preoperative cardiology evaluation and co-management in the perioperative period for individuals with these risk factors.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 North Piedras Street, El Paso, TX 79920. E-mail address for P.J. Belmont Jr.: E-mail address for G.P. Goodman: E-mail address for N. Kusnezov: E-mail address for B.R. Waterman:

2Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. E-mail address:

3Statistical Consulting Laboratory, University of Texas at El Paso, Bell Hall 131, El Paso, TX 79968. E-mail address:

4Department of Orthopaedic Surgery, University of Michigan, Ann Arbor Veterans Administration Hospital, 2800 Plymouth Road, Building 10, Room G016, Ann Arbor, MI 48109. E-mail address:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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