Aortic Stenosis and Total Hip Arthroplasty Complications: The Role of Perioperative Medications

BACKGROUND Total hip arthroplasty (THA) is commonly performed in older adults who have coexisting aortic stenosis (AS), a condition associated with fixed cardiac output and limited hemodynamic reserve. This study assessed 30-day complications and the impact of day-of-surgery medications in patients who have AS undergoing THA. METHODS A retrospective cohort study using a national database identified adults undergoing THA from January 2006 to January 2026. Individuals who had AS were propensity score-matched 1:1 to those who did not have AS, and 30-day complications were compared using risk ratios. After propensity score matching, 7,582 patients remained in each cohort. The 30-day outcomes were also compared between AS patients who received day-of-surgery tranexamic acid (TXA) and matched patients who did not. Cox regressions evaluated associations between day-of-surgery medications and 30-day stroke risk within the AS cohort. RESULTS Compared with matched controls, patients who had AS experienced significantly higher rates of 30-day complications following THA, particularly cardiovascular complications such as stroke and myocardial infarction (both P < 0.05). Aortic stenosis was also associated with increased risks of bacteremia, pneumonia, transfusion, acute renal failure, acute posthemorrhagic anemia, intensive care unit (ICU) care, and readmission (all P < 0.05). Among patients who had AS, day-of-surgery TXA use was associated with lower rates of 30-day transfusion, periprosthetic joint infection, ICU care, and readmission (all P < 0.05), without significant differences in cardiovascular or thromboembolic complications. Within the AS cohort, day-of-surgery thiazide diuretics, angiotensin-converting enzyme inhibitors, and beta blockers were independently associated with increased 30-day stroke hazard (all P < 0.05), whereas other evaluated day-of-surgery cardiovascular medication classes were not significantly associated with increased stroke risk. CONCLUSION Patients who have AS undergoing THA face elevated risks of early complications, particularly stroke and systemic events. Careful perioperative hemodynamic optimization and cardiovascular medication management may help mitigate 30-day morbidity.