Study determines prevalence, predictors of perioperative stroke after total joint arthroplasty

Mortazavi SMJ, Kakli H, Bican O, et al. Perioperative stroke after total joint arthroplasty: Prevalence, predictors, and outcome. JBJS (Am). ;92:2095-2101.doi:10.2106/JBJS.I.00940

The authors of this study attempted to determine the prevalence of – and outcome after – perioperative stroke following total joint arthroplasty while also evaluating the risk factors for development of perioperative stroke in an effort to identify a strategy that could minimize occurrences. They performed an observational study of 18,745 consecutive patients undergoing primary or revision total hip or total knee arthroplasty from 2000 to 2007 at their institution. They found an institutional perioperative stroke rate of 0.2% (36 of 18,745). The 36 patients who had a stroke included 17 men and 19 women with a mean age of 68.2 years. Average follow-up was 62 months.

First-year mortality among stroke patients was found to be 25% (9 of 36), and 4 of these 9 patients died in the hospital following total joint arthroplasty. According to the study, 3 patients received emergency intra-arterial thrombolysis, with 2 having complete neurologic recovery and one dying in the hospital. The researchers’ final regression model showed that a history of noncoronary heart disease, urgent – versus elective – surgery, general – versus regional – anesthesia, and an intraoperative arrhythmia or other alterations in the heart rate during surgery were significant predictors of perioperative stroke.

The final results of the study indicate that perioperative stroke is a rare but porentially devastating complication of total joint arthroplasty with high morbidity and mortality rates. The authors note that vigilant attention to prevent, detect and treat the complication in a timely manner could potentially alter the course of the disease.