Cardiotoxicity concerns in total joint arthroplasty

Table 2 Observed cardiac side effects in patients undergoing total joint arthroplasty with various implant types

Study	Implant type	Findings	Cardiac events observed
Brennan et al[1], 2024	General TJA	Elevated metal ion levels linked to adverse cardiac changes	Cardiomyopathy, heart failure, arrhythmias
Bellouard et al[2], 2024	Metal-on-polyethylene, metal-on-metal	Metal ions accumulate in cardiac tissues	Cardiomyopathy, arrhythmias, heart failure
Brüggemann and Hailer[4], 2024	General TJA	Elevated cobalt and chromium levels, immunological changes	Myocarditis, cardiomyopathy, arrhythmias
Spranz et al[3], 2024	Tantalum-based	Elevated blood tantalum levels	Potential cardiotoxicity, arrhythmias (further studies needed)
Stołtny et al[17], 2023	Metaphyseal hip arthroplasty with modular metal heads	High serum chromium and cobalt levels	Cardiomyopathy, myocardial fibrosis
Langton et al[19], 2022	Various (metal-on-metal, ceramic-on-polyethylene, ceramic-on-ceramic)	MoM implants have higher cardiotoxicity	Metal hypersensitivity, cardiomyopathy, heart failure
Linna et al[22], 2020	Occupational cobalt exposure (parallel to cobalt implants)	Increased cardiac events in chronic exposure	Arrhythmias, cardiomyopathy, heart failure
Berber et al[10], 2017	Metal-on-metal	Cobalt and chromium cardiotoxicity	Myocardial fibrosis, cardiomyopathy, heart failure

This table presents the incidence of cardiac events in patients undergoing total joint arthroplasty on the basis of the type of implant used. The studies listed explore the association between various implant materials and the occurrence of cardiac complications. Key findings include the influence of metal ion release on cardiac function, with metal-on-metal implants being associated with higher rates of cardiotoxicity, such as cardiomyopathy and heart failure. The table also highlights the role of immunological and inflammatory responses linked to elevated metal ion levels and their contribution to adverse cardiac outcomes, including myocarditis (inflammation of the heart muscle), which can contribute to or exacerbate conditions such as cardiomyopathy and arrhythmias. TJA: Total joint arthroplasty.