Does Previous Coronary Angiography Influence Complications in Total Joint Arthroplasty, and Should the Surgery Be Postponed? Publisher Pubmed



Ah Hoveidaei Amir HUMAN ; K Pirahesh KASRA ; M Poursalehian MOHAMMAD ; Sa Mansouri Seyed ALI ; M Mahalleh MEHRDAD ; P Dastjerdi PARHAM ; Sj Suresh Sukrit JUSHAY ; J Adolf JAKOB ; Jd Conway Janet D
Source: Journal of Arthroplasty Published:2025

Abstract

Background: Cardiovascular diseases are common in total joint arthroplasty (TJA) patients, many of whom undergo coronary angiography (CAG) before total hip (THA) or knee (TKA) arthroplasty. This study evaluated whether a history of CAG increases postoperative complications and how its timing affects outcomes. Methods: Using a national database, we analyzed patients undergoing THA or TKA between 2012 and 2020. Patients were grouped by CAG history (with and without stent placement) and timing intervals (within six, six to 12, 12 to 18, 18 to 24, and 24 to 36 months). Outcomes included readmission, myocardial infarction (MI), cerebrovascular accident (CVA), venous thromboembolism (VTE), surgical site infection, prosthetic joint infection (PJI), acute renal failure (ARF), revision surgery, and blood transfusion. Analysis used propensity score-matching and multivariate logistic regression. Results: Patients who underwent TKA with prior CAG (n = 4,602 with stent; n = 25,514 without stent) had significantly higher rates of MI, CVA, and blood transfusion compared to controls. These risks remained elevated across all CAG-to-TKA intervals. Acute renal failure, VTE, and readmission were significantly increased in earlier time intervals, but generally normalized with delays beyond 12 months, except in the stented subgroup, where elevated risks persisted up to 18 months. No significant differences were observed in 2-years PJI or revision rates. Patients who had a THA and a prior CAG (n = 3,422 with stent; n = 14,728 without stent) also experienced higher rates of MI, CVA, and blood transfusions. These risks did not decline with longer CAG-to-THA intervals. Readmission, VTE, and ARF were elevated in early time intervals, but normalized with delays beyond 12 months. Both PJI and revision rates were similar between groups. Conclusions: A history of CAG, especially with stent placement, is linked to higher postoperative complications, with MI and CVA risks remaining elevated regardless of surgery timing in both THA and TKA groups. Strategic TJA delay for other complications is recommended for patients with prior CAG undergoing arthroplasty. Level of Evidence: III. © 2025 Elsevier B.V., All rights reserved.