Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty.
BACKGROUND
There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary practice. The purpose of this study was to determine the frequency of clinically relevant myocardial infarction, pulmonary embolism, deep venous thrombosis, and death within 30 days after elective primary hip or knee arthroplasty treated according to contemporary perioperative management.


METHODS
The authors examined the medical records of consecutive patients undergoing hip or knee arthroplasty at their institution in a 10-yr period. Prospectively collected databases were used to identify patients with the diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis, or death using strict validation criteria and diagnostic-certainty categories.


RESULTS
A total of 10,244 patients underwent primary total hip or knee arthroplasty in the period of study. Of these, 224 patients had one or more adverse events (overall event rate: 2.2%; myocardial infarction: 0.4%; pulmonary embolism: 0.7%; deep venous thrombosis: 1.5%; death: 0.5%). Most adverse events (myocardial infarction, pulmonary embolism, and death) increased in frequency with older age, particularly for patients aged 70 yr or older. Myocardial infarction occurred more frequently in male patients. There were no differences in the overall event frequency between types of procedure. However, pulmonary embolism was highest in patients undergoing bilateral knee operations.


CONCLUSIONS
The overall frequency of serious complications within 30 days after primary total hip or knee arthroplasty with contemporary practice was 2.2%. Accurate knowledge of the perioperative risks associated with widely performed elective operations can be used to implement management strategies that may further improve patient outcomes and decrease cost.
Mantilla
Carlos B
CB
Department of Anesthesiology, Health Sciences Research, and Orthopedic Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. mantilla.carlos@mayo.edu
Horlocker
Terese T
TT
Schroeder
Darrell R
DR
Berry
Daniel J
DJ
Brown
David L
DL
D000328:Adult; D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000401:mortality*; D011655:Pulmonary Embolism / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D012042:Registries; D012737:Sex Factors; D020246:Venous Thrombosis / Q000191:economics / Q000453:epidemiology* / Q000401:mortality