Benign heart murmurs as a predictor for complications following total joint arthroplasty

James M. Friedman, Ricardo Couso, Michael Kitchens, Venus Vakhshori, Cody D. Hillin, Chia H. Wu, Joshua Steere, Jaimo Ahn, Eric Hume

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background There is scant literature examining the predictive role of heart murmurs in the absence of suspected structural heart disease on complications of non-cardiac surgery. We hypothesize the detection of heart murmurs in the absence of structural heart disease will help identify patients at risk for complications following total joint arthroplasty (TJA) surgery. Method This was a prospective cohort of patients undergoing TJA over a twenty-month period. The study was performed at a single academic institution with four subspecialty surgeons. Patients undergoing primary TJA who were over eighteen years old, gave informed consent, and had adequate documentation were included in the study. Patients with a preoperative murmur or a newly discovered postoperative murmur were compared against patients with no murmur. Surgery-related complications, performance with physical therapy, and discharge to a non-home facility were measured in each group. Findings 345 (63%) eligible patients were included. 20 (5.8%) patients had a documented preoperative murmur and 36 (10.4%) patients had a new postoperative murmur. No patient had concern for major structural heart disease. Preoperative murmurs independently predicted development of acute kidney injury (OR 7.729, p < 0.001; RR 1.36). Preoperative murmurs also predicted likelihood to be discharged to a non-home facility (OR 2.97, p = 0.03; RR 1.87). New postoperative murmurs independently correlated with decreased performance with physical therapy (OR 0.466, p = 0.045; RR 0.664). Interpretation Detection of heart murmurs both preoperatively and postoperatively is a low cost strategy to identify post-TJA surgical patients at risk for postoperative acute kidney injury, decreased physical performance, and discharge to non-home facilities. These patients may benefit from early fluid resuscitation and renally-dosed post-operative medications.

Original languageEnglish (US)
Pages (from-to)470-474
Number of pages5
JournalJournal of Orthopaedics
Issue number4
StatePublished - Dec 2017


  • Heart murmur
  • Surgical complications
  • Total joint arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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