Background: Total joint arthroplasty is one of the most successful orthopaedic surgical procedures. However, it carries a risk of perioperative mortality. The purpose of this study was to determine the mortality rate for patients undergoing primary total knee arthroplasty in a private-practice setting involving one surgeon in a nonteaching institution.

Methods: We analyzed 3048 consecutive primary total knee arthroplasties, performed between July 1976 and December 1996, with respect to mortality data (deaths that occurred intraoperatively, during hospitalization, and within ninety days after surgery) and comorbidities (major cardiovascular disease).

Results: The mortality rate was 0.46% (fourteen patients; one death per 217 procedures) within ninety days after primary total knee arthroplasty.

Conclusions: Increasing patient age and the presence of associated cardiovascular comorbidities were identified as risk factors for mortality. This information, we believe, is useful to patients, their families, physicians, and health-care planners in deciding when a total knee arthroplasty is appropriate.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.