Total Joint Arthroplasty and the Risk of Myocardial Infarction – A General Population, Propensity Score-Matched Cohort Study
Na Lu, MPH,1,2 Devyani Misra, MBBS,1 Tuhina Neogi, MD, DSc,1 Hyon K. Choi, MD, DrPH,1,2 and Yuqing Zhang, DSc1Hip Knee
Background
We sought to replicate recent findings that total knee arthroplasty (TKA) or total hip arthroplasty (THA) surgery substantially reduces the risk of serious cardiovascular events among osteoarthritis patients in a UK general population.
Methods
We conducted a time-stratified propensity score-matched cohort study for the outcome of myocardial infarction (MI). The study population included individuals aged ≥50 years who had a Readcode diagnosis of knee osteoarthritis (to evaluate TKA) or hip osteoarthritis (to evaluate THA) between January 2000 and December 2012.
Results
Among 13,849 patients who underwent TKA and 13,849 matched non-TKA controls 306 and 286 developed MI during the follow-up, respectively. During the first postoperative month, the risk of MI was substantially increased among TKA group compared with non-TKA group (hazard ratio 8.75; 95% CI, 3.11–24.62), and then gradually declined during the subsequent follow-up. The HR of the entire follow-up was 0.98 (95% CI, 0.82–1.18). The corresponding HRs for THA (n=6,063) compared with non-THA were 4.33 (95% CI, 1.24–15.21) and 0.87 (95% CI, 0.66–1.15), respectively. Using venous thromboembolism as a positive control outcome, both the first month and overall HRs of MI were substantially increased for TKA and for THA, respectively.
Conclusion
These findings provide the first general population-based evidence that TKA and THA among osteoarthritis patients are associated with a substantially increased risk of MI during the immediate postoperative period. However, its overall long-term impact was null, unlike the risk of venous thromboembolism that remained years after the procedure.
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