Researchers analyzed data from over 95,000 Danish patients who had a hip or knee replacement in Denmark between 1998 and 2007 in an effort to determine heart attack risk following joint replacement surgery. The researchers investigated the risk of heart attack of these patients compared to over 286,000 individuals who did not have joint replacement surgery. They found that the increased heart attack risk during the first two weeks following surgery is substantial. Individuals that had a total hip replacement had a 25-fold increased risk of heart attack while those having a total knee replacement had a 31-fold increased risk. After the initial two weeks following surgery, the risk of heart attack decreased substantially. Six weeks after surgery the risk of a heart attack occurring in those who had a total hip replacement dropped to 0.51% and to 0.21% for those who had a total knee replacement. The connection between joint replacement surgery and an increased risk of heart attack was the highest in patients over the age of 80. Conversely, there was no increased heart attack risk for individuals under 60 years of age who underwent joint replacement surgery. The researchers report that while it’s not clear if joint replacement procedures trigger a heart attack, it is reasonable to believe that they can.
The researchers state that there are many factors that could be involved in an increase in heart attack risk following joint replacement surgery. They state that surgery poses a risk because the anesthesia that is needed to perform the surgery increases stress levels in patients. Furthermore, cutting into bones can possibly trigger blood clot formation in the bone marrow. Additionally, during surgery there is blood loss and oxygen deprivation both of which are stressors that can increase the risk of heart attack. Not to mention that many patients experience high levels of stress prior to having surgery which can increase their risk of heart attack even before the surgery occurs. With all of these risk factors of joint replacement surgery it is not surprising that heart attack risk increases with these procedures.
Due to the increased risk of heart attack following joint replacement surgery, patients should speak with their doctor prior to surgery to discuss their pre-operative cardiac risk and determine their post-operative cardiac care needs, especially if they have an existing heart condition. Proper management of cardiac conditions will help to minimize the risk of heart attack and post-operative cardiac care will help to prevent heart attacks from occurring in this high risk population following joint replacement surgery. Even in patients without pre-existing heart conditions, cardiac care should be a component of their post-operative rehabilitation. Educating patients before and after surgery on the importance of cardiac care is vital in an effort to prevent a life-altering heart attack from occurring.
With the increasing age of the population, joint replacements of the hip and knee are going to become even more commonplace. Currently doctors are concerned with rehabilitating the affected joint; however, the findings from this current study suggest that cardiac care should also be a top priority when planning for post-operative care and patient discharge.