Total joint replacement raises short-term risk of heart attack

By John Murphy, MDLinx
Published January 6, 2016

Key Takeaways

Osteoarthritis patients who have total knee or total hip replacement surgery are at increased risk of heart attack in the early postoperative period. In the long term, this heart attack risk gradually goes away, but a risk for venous thromboembolism remains for years after the procedure, according to a study published online August 31, 2015 in Arthritis & Rheumatology.

“While evidence shows that joint replacement surgery improves pain, function, and quality of life for the osteoarthritis patient, the impact of cardiovascular health has not been confirmed,” said lead study author Yuqing Zhang, DSc, Professor of Medicine and Epidemiology at Boston University School of Medicine in Boston, MA.

“Our findings provide the first general population-based evidence that osteoarthritis patients who have total knee or total hip replacement surgery are at increased risk of heart attack in the immediate postoperative period,” Dr. Zhang said. “The long-term risk of heart attack was insignificant, but risk of blood clots in the lung remained for years after surgery to replace a hip or knee damaged by osteoarthritis.”

The study included 13,849 patients who underwent total knee replacement surgery and 13,849 matched controls who did not have surgery. The investigation also included another 6,063 patients who had total hip replacement surgery and 6,063 matched controls. Patients were 50 years of age or older and diagnosed with knee or hip osteoarthritis between January 2000 and December 2012, and had never had a heart attack before.

Findings showed that 306 patients in the total knee arthroplasty group and 286 in the non-surgical group developed myocardial infarction during the follow-up period. Risk of heart attack was significantly higher during the first postoperative month in those who had knee replacement surgery (hazard ratio 8.75; CI 95%) and hip replacement surgery (hazard ratio 4.33; CI 95%) compared with those in the non-surgical group. But this risk quickly declined to zero after a 6 months of follow-up in the knee replacement group and after 1 month of follow-up in the hip replacement group.

Venous thromboembolism, however, was a significant risk during the first month and continued to be a long-term risk for those having total knee or total hip arthroplasty, the researchers found.

“It remains unclear whether the perioperative management of antithrombotic agents (i.e., discontinuation of low-dose aspirin and initiation of inpatient anticoagulation prophylaxis) can explain the increased risk of myocardial infarction after total joint arthroplasty surgery in osteoarthritis patients,” the authors wrote. “Regardless, 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.”

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