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Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the 'asymptomatic' patient


Elsiwy, Y and Symonds, T and Doma, K and Hazratwala, K and Wilkinson, M and Letson, H, Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the 'asymptomatic' patient, Journal of Orthopaedic Surgery and Research, 15 Article 513. ISSN 1749-799X (2020) [Refereed Article]

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Copyright Statement

The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License (, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

DOI: doi:10.1186/s13018-020-02042-5


Background: No validated pre-operative cardiac risk stratification tool exists that is specific for total hip and total knee arthroplasty (THA and TKA, respectively). To reduce the risk of post-operative cardiac complication, surgeons need clear guidance on which patients are likely to benefit from pre-operative cardiac optimisation. This is particularly important for asymptomatic patients, where the need is harder to determine.

Methods: Primary THA and TKA performed between January 1, 2010, and December 31, 2017, were identified from a single orthopaedic practice. Over 25 risk factors were evaluated as predictors for patients requiring additional cardiac investigation beyond an ECG and echocardiogram, and for cardiac abnormality detected upon additional investigation. A multivariate logistic regression was conducted using significant predictor variables identified from inferential statistics. A series of predictive scores were constructed and weighted to identify the influence of each variable on the ability to predict the detection of cardiac abnormality pre-operatively.

Results: Three hundred seventy-four patients were eligible for inclusion. Increasing age (p < 0.001), history of cerebrovascular accident (p = 0.018), family history of cardiovascular disease (FHx of CVD) (p < 0.001) and decreased ejection fraction (EF) (p < 0.001) were significant predictors of additional cardiac investigation being required. Increasing age (p = 0.003), male gender (p = 0.042), FHx of CVD (p = 0.001) and a reduced EF (p < 0.001) were significantly predictive for the detection of cardiac abnormality upon additional cardiac investigation.

Conclusions: Increasing age, male gender, FHx of CVD and decreased ejection fraction are important risk factors to consider for pre-operative cardiac optimisation in THA and TKA patients. These findings can be applied towards future predictive models, to determine which asymptomatic patients are likely to benefit from pre-operative cardiac referral.

Item Details

Item Type:Refereed Article
Keywords:cardiac, arthroplasty, TKA, THA, risk factor, complication
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Surgery
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Wilkinson, M (Dr Matthew Wilkinson)
ID Code:151685
Year Published:2020
Web of Science® Times Cited:2
Deposited By:Medicine
Deposited On:2022-08-03
Last Modified:2022-09-16
Downloads:6 View Download Statistics

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