Postoperative Outcomes by Timing of Total Hip and Knee Arthroplasty Following Coronary Revascularization

Background Current guidelines recommend delaying elective surgery after coronary revascularization, but the relationship between timing for total joint arthroplasty (TJA) and postoperative outcomes remains unclear. We investigated the association between timing of TJA after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and postoperative outcomes. Methods The PearlDiver database was used to identify patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) within 24 months after PCI or CABG between 2010 to 2022. Patients were stratified by timing of surgery: <6 months, 6-12 months, or 12-24 months post-revascularization. Propensity score matching was performed to balance baseline demographics and comorbidities. Primary outcomes included 90-day complications and 2-year implant-related complications. Results Among matched cohorts, TJA within 6 months of CABG was associated with significantly higher odds of acute kidney injury (THA: OR=2.75, 95% CI=1.53-5.26, P=0.001; TKA: OR=2.59, 95% CI=1.40-5.19, P=0.004) and transfusion needs (THA: OR=2.40, 95% CI=1.32-4.66, P=0.006; TKA: OR=1.87, 95% CI=1.08-3.43, P=0.032). TJA within 6 months of PCI did not show increased odds of major adverse events compared to later intervals (all P>0.05). Cardiac arrest odds were elevated when THA, but not TKA, was performed 12-24 months after CABG (OR=7.97, 95% CI=1.57-145.42, P=0.046) or PCI (OR=7.38, 95% CI=2.17-46.23, P=0.007). Conclusions For patients undergoing TJA following coronary revascularization, postoperative risk profiles appear to differ by intervention type. Patients undergoing TJA ≥6 months after PCI had comparable odds of major adverse events to later intervals. In contrast, patients undergoing TJA after CABG demonstrated persistently elevated risks of acute kidney injury across time intervals, suggesting that perioperative risk may remain heightened beyond the early postoperative period. These findings highlight potential differences in risk trajectories by revascularization modality and suggest that further investigation is needed to better inform timing recommendations.