ArticleArthroplasty today2026
Total Knee Arthroplasty in the Presence of Congenital Heart Disease: An Under-Recognized Risk.
Article in Arthroplasty today, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
Background: Adults with congenital heart disease (CHD) increasingly present for noncardiac surgery. Total knee arthroplasty (TKA) induces significant hemodynamic and thromboembolic stress and, in patients with intracardiac shunts such as patent foramen ovale (PFO) or atrial septal defect (ASD), may precipitate paradoxical embolism and other under-recognized complications. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Embase, and Web of Science were searched from inception to December 2024. Peer-reviewed original studies reporting outcomes of TKA in patients with CHD were eligible. Two reviewers independently screened studies, extracted data, and appraised methodological quality using the Joanna Briggs Institute tools. Given the heterogeneity and predominance of case-based evidence, findings were synthesized narratively. Results: Eleven case reports (1996-2023) involving 11 patients met the inclusion criteria. Most patients were female (72.7%), with a mean age of 67.3 years (range, 52-84). PFO was the most frequent lesion (81.8%), followed by ASD (18.2%). Symptom onset was commonly early: 36.4% occurred perioperatively and 36.4% within the first 2 postoperative days. Neurological manifestations predominated (72.7%), with respiratory symptoms (27.3%) and limb ischemia (9.1%) less frequent. Transesophageal echocardiography confirmed the diagnosis in 72.7% of cases. Paradoxical cerebral embolism/stroke was the principal complication; pulmonary embolism (18.2%) and venous thromboembolism (9.1%) were also reported. Conclusions: TKA in patients with CHD, particularly PFO or ASD, may be complicated by early paradoxical embolic events. New neurological deficits or unexplained hypoxemia warrant urgent evaluation for intracardiac shunting. Higher-quality studies are needed to guide screening and prevention strategies.
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