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Cardiac interventions on total knee arthroplasty: a national inpatient sample-based analysis

  • Knee Arthroplasty
  • Published:
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Comorbid cardiovascular diseases have been associated with poor outcomes in total knee arthroplasty (TKA); however, our understanding of TKA with prior cardiac treatment procedures has largely been undocumented. In this study, we examined TKA patients who had undergone different cardiac interventions that addressed their condition. The purpose was to characterize and compare outcomes for a growing patient population not yet analyzed.

Materials and methods

The 2016–2019 Nationwide Inpatient Sample database was queried for 558,256 patients who had TKA (ICD-10CM). Backgrounds significant for pacemaker [PM] (n = 8025), coronary artery bypass [CABG] (n = 12,683), heart valve surgery [HV] (n = 4125), or coronary stent [CS] (n = 19,483) were compared against those without, across demographics, admission information, and various complications.


Cardiac interventions were associated with increased age, male gender, length of stay, and cost of care. CABG, and Stent groups had more diabetics, but HV had significantly fewer (p = 0.008). PM and HV had significantly less tobacco use and, in addition to CABG, less obesity. Postoperatively, mortality was elevated in the PM [Odds ratio (OR) 2.89, p = 0.008], CABG (OR 2.53, p = 0.006) and CS group (OR 1.94, p = 0.018), but not HV. Myocardial infarctions were elevated in the CABG (OR 3.874) and CS group (OR 5.11) (p < 0.001). PM, HV, and CS had increased odds of periprosthetic fracture by 2.15-fold (p < 0.001), 2.09-fold (p < 0.001), 1.29-fold (p = 0.011) respectively. HV saw increased periprosthetic mechanical complications (OR 1.48, p = 0.006). CABG increased the odds of deep surgical site infection 14.23-fold and CS 9.22-fold (p < 0.001). Postoperative pneumonia was increased in PM, CABG, and CS groups (OR 2.15,), (OR 2.21,), (OR 1.64,) (p < 0.001).


Patients who have undergone cardiac intervention are generally at risk for adverse stays. Furthermore, risk factors and complications vary between the groups. Our analysis emphasizes the importance of individualized medical care and as a basis for electing and informing patients for TKA.

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Data availability

All data comes from the NIS database.


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The authors declare that no funds, grants, or other support were received during preparation and construction of this manuscript.

Author information

Authors and Affiliations



All authors contributed to the study conception and design. Data collection was performed by SS and analysis was performed by EM. The first draft of the manuscript was written by EM, and authors commented on previous versions to approve the final manuscript.

Corresponding author

Correspondence to Enzo C. Mesarick.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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The UTSW Institutional Review Board has confirmed that no ethical approval is required, exempt.

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Appendix A

Appendix A

ICD Codes

Obese codes

Morbidly obese codes

Comorbidities codes

Medical complications codes

Surgical complications codes



Diabetes without complications

Acute renal failure

Periprosthetic fracture




N170, N171, N172, N178, N179

T84010A, T84011A, T84012A, T84013A, T84018A, T84019A, M9665, M96661, M96662, M96669, M96671, M96672, M96679, M9669, M9701XA, M9702XA, M9711XA, M9712XA



Diabetes with complications

Myocardial infarction

Periprosthetic dislocation




I2101, I2102, I2111, I2113, I12114, I12119, I2121, I12129, I21A1

T84020A, T84021A, T84022A, T84023A, T84028A, T84029A



Tobacco-related disorder

Blood loss anemia

Periprosthetic mechanical complications





T84090A, T84091A, T84092A, T84093A, T84098A, T84099A




Periprosthetic infection


J189, J159, J22

T8450XA, T8451XA, T8452XA, T8453XA, T8454XA, T8459XA


Blood transfusion

Superficial SSI





Pulmonary embolism

Deep SSI


I2602, I2609, I2692, I2699






I82401, I82402, I82403, I82409, I82411, I82412, I82413, I82419, I82421, I82422, I82423, I82429, I82431, I82432, I82433, I82439, I82441, I82442, I82443, I82449, I82491, I82492, I82493, I82499, I824Y1, I824Y2, I824Y3, I824Y9, I824Z1, I824Z2, I824Z3, I824Z4





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Mesarick, E.C., Mounasamy, V. & Sambandam, S. Cardiac interventions on total knee arthroplasty: a national inpatient sample-based analysis. Arch Orthop Trauma Surg 144, 2229–2238 (2024).

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