Advertisement

What are the Outcomes After Primary Total Hip and Knee Arthroplasty in Patients With Prior Cerebrovascular Accidents?

      Abstract

      Background

      For patients who have a history of cerebrovascular accident (CVA) with neurological sequelae undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA), we sought to determine mortality rate, implant survivorship, complications, and clinical outcomes.

      Methods

      Our total joint registry identified CVA sequelae patients undergoing primary THA (n = 42 with 25 on affected hip) and TKA (n = 56 with 34 on affected knee). Patients were 1:2 matched based upon age, sex, body mass index, and surgical year to a non-CVA cohort. Mortality and implant survivorship were evaluated via Kaplan-Meier methods. Clinical outcomes were assessed via Harris Hip scores or Knee Society scores . Mean follow-up was 5 years (range, 2-12).

      Results

      For CVA sequelae and non-CVA patients, respectively, the 5-year patient survivorship was 69 versus 89% after THA (HR = 2.5; P = .006) and 56 versus 90% after TKA (HR = 2.4, P = .003). No significant difference was noted between groups in implant survivorship free from any reoperation after THA (P > .2) and TKA (P > .6). Postoperative CVA occurred at an equal rate in CVA sequelae and non-CVA patients after TKA (1.8%); none after THA in either group. The magnitude of change in Harris Hip scores (P = .7) and Knee Society scores (P = .7) were similar for CVA sequelae and non-CVA patients.

      Conclusion

      Complications, including the risk of postoperative CVA, implant survivorship, and outcome score improvement are similar for CVA sequelae and non-CVA patients. A 2.5-fold increased risk of death at a mean of 5 years after primary THA or TKA exist for CVA sequelae patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Global Health Estimates
        Geneva: World Health Organization.
        ([accessed 20.03.20])
        • Johnston S.C.
        • Mendis S.
        • Mathers C.D.
        Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling.
        Lancet Neurol. 2009; 8: 345-354
        • O’Donnell M.J.
        • Xavier D.
        • Liu L.
        • Zhang H.
        • Chin S.L.
        • Rao-Melacini P.
        • et al.
        Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.
        Lancet. 2010; 376: 112-123
        • Skolarus L.E.
        • Burke J.F.
        • Brown D.L.
        • Freedman V.A.
        Understanding stroke survivorship: expanding the concept of poststroke disability.
        Stroke. 2014; 45: 224-230
        • Sprigg N.
        • Selby J.
        • Fox L.
        • Berge E.
        • Whynes D.
        • Bath P.M.
        Very low quality of life after acute stroke: data from the efficacy of nitric oxide in stroke trial.
        Stroke J Cereb Circ. 2013; 44: 3458-3462
        • Owolabi M.O.
        • Akarolo-Anthony S.
        • Akinyemi R.
        • Arnett D.
        • Gebregziabher M.
        • Jenkins C.
        • et al.
        Members of the H3Africa Consortium. The burden of stroke in Africa: a glance at the present and a glimpse into the future.
        Cardiovasc J Afr. 2015; 26: S27-S38
        • Jørgensen M.E.
        • Torp-Pedersen C.
        • Gislason G.H.
        • et al.
        Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery.
        JAMA. 2014; 312: 269-277
        • Christiansen M.N.
        • Andersson C.
        • Gislason G.H.
        • Torp-Pedersen C.
        • Sanders R.D.
        • Føge Jensen P.
        • et al.
        Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery: the importance of operative timing.
        Anesthesiology. 2017; 127: 9-19
        • Menendez M.E.
        • Greber E.M.
        • Schumacher C.S.
        • Lowry Barnes C.
        Predictors of acute ischemic stroke after total knee arthroplasty.
        J Surg Orthop Adv. 2017; 26: 148-153
        • Harris W.H.
        Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty, an end-result stage using a new method of result evaluation.
        J Bone Joint Surg Am. 1969; 51: 737-755
        • Insall J.N.
        • Dorr L.D.
        • Scott R.D.
        • Scott W.N.
        Rationale of the Knee Society clinical rating system.
        Clin Orthop Relat Res. 1989; 248: 13-14
        • Lackland D.T.
        • Roccella E.J.
        • Deutsch A.F.
        • Fornage M.
        • George M.G.
        • Howard G.
        • et al.
        American heart association stroke council; council on cardiovascular and stroke nursing; council on quality of care and outcomes research; council on functional genomics and translational biology. Factors influencing the decline in stroke mortality: a statement from the American heart association/American stroke association.
        Stroke. 2014; 45: 315-353
        • Powers W.J.
        • Rabinstein A.A.
        • Ackerson T.
        • Adeoye O.M.
        • Bambakidis N.C.
        • Becker K.
        • et al.
        Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association.
        Stroke. 2019; 50: e344-e418
        • Brønnum-Hansen H.
        • Davidsen M.
        • Thorvaldsen P.
        • Danish MONICA Study Group
        Long-term survival and causes of death after stroke.
        Stroke. 2001; 32: 2131-2136
        • Langhorne P.
        • Stott D.J.
        • Robertson L.
        • MacDonald J.
        • Jones L.
        • McAlpine C.
        • et al.
        Medical complications after stroke: a multicenter study.
        Stroke. 2000; 31: 1223-1229
        • Roth E.J.
        • Lovell L.
        • Harvey R.L.
        • Heinemann A.W.
        • Semik P.
        • Diaz S.
        Incidence of and risk factors for medical complications during stroke rehabilitation.
        Stroke. 2001; 32: 523-529
        • Mortazavi S.M.
        • Kakli H.
        • Bican O.
        • Moussouttas M.
        • Parvizi J.
        • Rothman R.H.
        Perioperative stroke after total joint arthroplasty: prevalence, predictors, and outcome.
        J Bone Joint Surg Am. 2010; 92: 2095-2101
        • Haynes M.S.
        • Alder K.D.
        • Bellamkonda K.
        • Kuzomunhu L.
        • Grauer J.N.
        Incidence, predictors, and timing of post-operative stroke following elective total hip arthroplasty and total knee arthroplasty.
        PLoS One. 2020; 15: e0239239
        • Rasouli M.R.
        • Tabatabaee R.M.
        • Maltenfort M.G.
        • Chen A.F.
        Acute stroke after total joint arthroplasty: a population-based trend analysis.
        J Clin Anesth. 2016; 34: 15-20
        • Ullberg T.
        • Zia E.
        • Petersson J.
        • Norrving B.
        Changes in functional outcome over the first year after stroke: an observational study from the Swedish stroke register.
        Stroke. 2015; 46: 389-394