Total knee arthroplasty in patients with cardiomyopathy: A large matched cohort analysis

Introduction: Patients with cardiomyopathy, such as primary, infectious, inflammatory, secondary, and unspecified cardiomyopathy, may need total knee arthroplasty. This study aims to investigate the demographic and thirty-day postoperative complications of patients with cardiomyopathy who receive TKA. Methods: The PearlDiver database was utilized to develop a retrospective cohort study. Patients of all demographics diagnosed with cardiomyopathy who underwent TKA based on the ICD-9, ICD-10, and CPT diagnosis codes were included. A collection of preoperative and postoperative variables was compared between patients with cardiomyopathy and those without cardiomyopathy following TKA. A matched and unmatched univariant analysis was conducted to compare these two populations using a 1:1 propensity match algorithm. Statistical significance was set at p < 0.05, and odds ratios with 95 % confidence intervals were reported. Results: In 163,625 patients with cardiomyopathy, patients were older and had a 3.076 times greater risk of congestive heart failure (p < 0.0001), 2.4537 times greater risk of acute myocardial infarction (p < 0.0001), 1.995 times greater risk of postoperative shock (p < 0.0001), 1.2483 times greater risk of deep vein thrombosis (p < 0.0001), 1.5590 times greater risk of pulmonary embolism (p < 0.0001), 1.3694 times greater risk of sepsis (p < 0.0001), 1.3572 times greater risk of acute kidney injury (p < 0.0001)., 1.2277 times greater risk of readmissions (p < 0.0001), 1.2588 times greater risk of revisions (p < 0.0001), and higher risks of local complications such as periprosthetic joint infection (p = 0.0397), periprosthetic mechanical complication (p = 0.0213), manipulation under anesthesia (p = 0.0012) and wound dehiscence (p < 0.0001). Conclusion: Cardiomyopathy is associated with an increased risk of congestive heart failure, acute myocardial infarction, postoperative shock, deep vein thrombosis, pulmonary embolism, sepsis, acute kidney injury, readmissions, revisions, periprosthetic joint infection, mechanical complications, manipulation under anesthesia, and wound dehiscence. These results suggest that cardiomyopathy is a critical risk factor of adverse postoperative outcomes following TKA.