Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

Abstract

BackgroundCardiac complication represents a major cause of morbidity and mortality after total joint arthroplasty, thus necessitating investigation into the associated risks in total hip arthroplasty and total knee arthroplasty. There remains a lack of clarity for many risk factors in the current literature. The aim of this systematic review is to assess the most recent published literature and identify the risk factors associated with cardiac complication in total hip arthroplasty and total knee arthroplasty.MethodsScopus, PubMed, CINHAL, and Cochrane were searched to identify studies published since 2008 reporting on risk factors associated with cardiac complication in elective primary in total hip arthroplasty and total knee arthroplasty in patients ≥18 years old with osteoarthritis. Reported odds ratios, hazard ratios, and relative risk were the principal summary measures collected. The included studies were too heterogeneous to enable meta-analysis.ResultsFifteen studies were included in this systematic review. Increasing age and history of cardiac disease were found by most studies to be positively associated with risk of cardiac complication. There was no strong association found between obesity and cardiac complication. The evidence for other risk factors was less clear in the examined literature, although there is suggestive evidence for male gender and cerebrovascular disease increasing risk.ConclusionsIncreasing age and history of cardiac disease increases the risk of cardiac complication after total hip arthroplasty and total knee arthroplasty. Other risk factors commonly attributed to increased risk in non-cardiac surgery including hypertension and obesity require further evaluation in arthroplasty.Systematic review registrationA detailed protocol was published in the PROSPERO database (registration number CRD42018095887) for this systematic review.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-1058-9) contains supplementary material, which is available to authorized users.

Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the ‘asymptomatic’ patient

“…Data was collected by two investigators from electronic records. Variables were selected based on a prior systematic review examining risk factors for cardiac complication after TKA and THA [ 14 ]. The predictor variables included patient demographics; medical history (cardiac and non-cardiac); family history of cardiac disease (FHx of CVD), defined as history of myocardial infarction, cardiac arrest, sudden cardiac death, ischaemic heart disease, coronary artery disease or congestive heart failure in a first-degree relative; and results of baseline cardiac investigation (ECG and ECHO).…”

“…The predictor variables included patient demographics; medical history (cardiac and non-cardiac); family history of cardiac disease (FHx of CVD), defined as history of myocardial infarction, cardiac arrest, sudden cardiac death, ischaemic heart disease, coronary artery disease or congestive heart failure in a first-degree relative; and results of baseline cardiac investigation (ECG and ECHO). Data extracted were age, gender, body mass index (BMI), diabetes, hypertension (HTN), hypercholesterolaemia, smoking history, alcohol history, chronic kidney disease, chronic obstructive pulmonary disease, asthma, obstructive sleep apnoea, chronic heart failure, myocardial infarction, coronary artery disease (CAD), valvular disease, arrhythmia, peripheral vascular disease, cerebrovascular accident (CVA) and venous thromboembolism [ 14 ]. The outcome variables for this analysis were (1) additional cardiac investigation (ACI) ordered by cardiologist (e.g.…”

“…Previous studies have identified risk factors for post-operative cardiac complication in TKA and THA cohorts; however, a recent systematic literature review identified several limitations within the current literature [ 14 ]. Firstly, there is inconsistency regarding which risk factors are significant predictors of cardiac complication.…”

“…Based on prior analysis, we hypothesised that age and history of cardiac disease will be significant predictors. However, we also sought to further determine the predictive value of additional potentially important risk factors [ 14 ]. Significant risk factors identified in this study may contribute to the development of a more comprehensive cardiac risk stratification tool that may better guide pre-operative cardiac referral for the ‘asymptomatic’ TJA patient.…”

Robotic Technology Can Be a Useful Tool in TKR in a Post-Cabg Patient: A Case Report and Literature Review

“…Total knee replacement (TKR) has traditionally been seen as a highly demanding surgery associated with major blood loss in patients belonging to older age group often having comorbidities. Older age group, male gender and pre-existing cardiac disease increase the risk [1][2][3][4][5] of complications after TKR surgery. Clinically signicant complications like myocardial infarction (MI), pulmonary embolism (PE), deep vein thrombosis (DVT) and death are known to occur following total knee arthroplasty (TKA) with an overall frequency of 6 2.2 %.…”