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

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).