New cardio risk factors seen after joint surgery

NEW YORK (Reuters Health) - In addition to confirming previously identified risk factors for cardiovascular complications after total joint replacement surgery, researchers have now found that bilateral (involving both sides of the body, such as two hip or knee replacements), as well as revision operations, are associated with increased risk.

"Revision joint replacement and bilateral surgery are much more prolonged operations than primary unilateral joint replacement," Dr. Jeffrey N. Katz, from Brigham and Women's Hospital in Boston, said in a statement. "These findings suggest an increased risk with more prolonged surgery."

The results, reported in the journal entitled Arthritis and Rheumatism, come from a study of 209 patients with a history of heart attack, heart failure, unstable angina (chest pain), arrhythmia (irregular heart beat), symptoms of low blood pressure, or a blot clot in the lung at admission for total joint replacement, and 209 patients matched to characteristics of the others, but did not have cardiovascular complications.

In line with prior findings, an increased risk of heart disease was 0.7-times greater in older patients, 2.6-greater in those with history of arrhythmia and 1.6-times greater in patients with a history of coronary artery disease, heart attack, heart failure, or valvular heart disease.

The strongest risk factor, however, was one of the newly identified ones, bilateral surgery, which increased the risk by 3.5-fold. Revision surgery also increased the risk by 2.2-fold.

"Clinicians can use this information to better estimate the risk of cardiovascular complications following total joint replacement surgery," Katz said, "and, ultimately, to prevent and better manage these complications."

SOURCE: Arthritis and Rheumatism, July, 2008.