Arthroplasty associated with increased risk of heart attack in early postoperative period
The immediate postoperative risk of myocardial infarction following total joint arthroplasty may have been previously underappreciated, authors noted.
Osteoarthritis patients who have total knee or hip joint replacement surgery may be at increased risk of myocardial infarction in the early postoperative period but not in the long term, although risk for venous thromboembolism remained years after the procedure, a study found.
The time-stratified propensity score-matched cohort study included 13,849 patients who underwent total knee replacement surgery and 13,849 matched controls who did not have surgery. Patients were 50 years of age or older and were diagnosed with knee or hip osteoarthritis between January 2000 and December 2012. Results were published online Aug. 31 in Arthritis & Rheumatology.
During the follow-up period, 306 patients in the arthroplasty group and 286 in the nonsurgical group had a myocardial infarction (MI). During the first postoperative month, the risk of MI was substantially increased among the knee replacement group compared with the non-knee replacement group (hazard ratio [HR], 8.75; 95% CI, 3.11 to 24.62) and then gradually declined during follow-up. The risk of MI was also substantially increased among the hip replacement group (HR, 4.33; 95% CI, 1.24 to 15.21) compared with non-hip replacement group (HR, 0.87; 95% CI, 0.66 to 1.15).
Looking at venous thromboembolism, both the first-month and overall HRs of MI were substantially increased for patients who had knee and hip replacements. Hazard ratios of venous thromboembolism among patients who underwent total knee arthroplasty (compared to controls who didn't have surgery) were 63.00 at 1 month, 19.36 at 3 months, 10.31 at 6 months, 6.26 at 1 year, 2.98 at 2 years, 2.43 at 3 years, and 2.18 for the entire follow-up period.
The authors wrote, “… our findings suggest that the immediate postoperative risk of myocardial infarction following total joint arthroplasty may have been previously underappreciated, and further measures to prevent this serious event may need to be considered. In contrast, improvements in patients' pain, function, and health-related quality of life, as well as the reduced use of nonsteroidal anti-inflammatory drugs after total joint arthroplasty might lead to potential long term benefits on cardiovascular outcomes.”