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.