Association Between Total Joint Arthroplasty and Surgical Complications in Patients With Valvular Heart Replacement: An Observational Study Publisher



Ah Hoveidaei Amir HUMAN ; S Esmaeili SINA ; H Saffar HOMINA ; A Ghanaatpisheh AREF ; F Zarepour FATEMEH ; A Shirinezhad AMIRHOSSEIN ; Ht Shu Henry T ; Jd Conway Janet D
Source: Arthroplasty Today Published:2025

Abstract

Background: Valvular heart replacement (VHR) is associated with increased cardiac complications and mortality risk in patients undergoing noncardiac surgery. There are limited data on total joint arthroplasty outcomes in patients with a prior history of VHR. Methods: In this retrospective cohort study, we identified patients who underwent elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) between 2010 and 2022 using the PearlDiver national database. Patients with a history of VHR were matched with a control group using propensity score matching. Statistical analyses were conducted using R statistical software. Results: We identified 874 patients with THA and 1162 patients with TKA. No significant difference in surgical or medical complications was observed in THA patients with a history of VHR compared to the matched control group, regardless of the time interval between procedures. In contrast, for TKA patients, VHR was associated with a higher incidence of periprosthetic joint infection (odds ratio [OR] = 1.54; 95% confidence interval [CI]: 1.02-2.33; P = .049), particularly when performed within 3 months before TKA (OR = 4.71; 95% CI: 1.04-15.48). Additionally, patients who underwent VHR 3 to 6 months before TKA had a significantly higher incidence of cerebrovascular accident (OR = 2.61; 95% CI: 1.20-5.24; P = .011). Conclusions: VHR was not associated with an increased risk of complications following THA. However, about TKA patients, a history of VHR was linked to a higher risk of periprosthetic joint infection, and an increased incidence of cerebrovascular accident in those who had VHR 3 to 6 months prior. Future studies are needed to develop strategies for reducing complications. Level of Evidence: III (Retrospective cohort). © 2025 Elsevier B.V., All rights reserved.