The news just doesn’t ever seem to get better for joint replacements! In the wake of all the studies demonstrating the incidence of serious hip and knee replacement risks and complications, a new study finds that men experience a much greater joint replacement heart attack risk following total hip or knee replacement surgery.
Why would joint replacement increase the risk of heart attack at all? To understand that, you need to understand that a joint replacement is actually the amputation of that joint with the insertion of a prosthesis. When you completely cut out a joint from a patient there is severe trauma to the blood vessels and bone marrow space. This likely leads to a higher risk of blood clots, some of which may make it to the heart. In addition, for some patients, the physical stress to the body of undergoing the joint amputation may be enough alone.
This new study identified 37,881 total hip replacement patients and 59, 564 total knee replacement patients. To isolate complications related to sex, the researchers used metrics to adjust for age, provider volume, frailty and comorbidity and included outcomes between 90 days to 2 years from surgery. The results were very concerning but not surprising. Male total hip patients had a significantly greater risk of acute myocardial infarction (heart attack). Male total knee replacement patients had a 79% risk of acute myocardial infarction, a 67% risk of deep infection and a 49% risk for revision. Female patients were considered to be healthier overall, and though there was a much greater incidence of frailty, it did not impact heart attack risk.
The upshot? There will always be cases in which joint replacement is necessary. However, given that research has shown 1/3 of knee replacements performed have no medical basis, and recent data has shown there have been significant increases in the number of knee replacements being done as a result of recent changes to the healthcare system, these statistics are concerning. Hopefully, further studies will be done and eventually the research on which patients are at risk for things like chronic pain and heart attacks will filter down to the physicians and medical systems performing these surgeries. In the meantime, being an informed patient is more important than ever.