Impact of Stroke History and Interval on Outcomes of Total Hip Arthroplasty: A Retrospective Cohort Study.
There is limited data on perioperative management of patients with prior stroke undergoing total hip arthroplasty (THA). This study evaluates timing for THA following stroke. We assessed (1) complications at 90 days, 1 year, and 2 years; (2) timing of stroke and THA; and (3) risk factors for periprosthetic joint infection (PJI).
We retrospectively analyzed a national database to identify 35,496 THA patients. Cohorts were stratified by time from stroke to surgery: no stroke (n = 20,000), stroke within 6 months (n = 5,535), 12 months (n = 3,165), 18 months (n = 2,614), 24 months (n = 2,168), and 30 months (n = 2,014). Complication rates were compared at 90 days, 1 year, and 2 years, and multivariate analysis identified risk for PJI.
Stroke within 6 months of THA was associated with higher PJI revision rates at 90 days and 2 years (all P < .046). Stroke within 18 months increased PJI revision risk across all time points (all P < .047). Several risk factors were associated with this complication, including hypertension, obesity, and tobacco use. Stroke 6 to 18 months before THA was associated with higher rates of 90-day complications, including deep vein thrombosis, cardiac arrest, and surgical site infections. Patients with stroke prior to THA had significant risks of revision for PJI and aseptic revisions at 1 and 2 years, with risks depending on time between stroke and THA (all P < .002).
A history of stroke increases postoperative complications after THA, particularly PJI. We recommend patients defer THA for at least 18 months following a stroke to minimize risks.
We retrospectively analyzed a national database to identify 35,496 THA patients. Cohorts were stratified by time from stroke to surgery: no stroke (n = 20,000), stroke within 6 months (n = 5,535), 12 months (n = 3,165), 18 months (n = 2,614), 24 months (n = 2,168), and 30 months (n = 2,014). Complication rates were compared at 90 days, 1 year, and 2 years, and multivariate analysis identified risk for PJI.
Stroke within 6 months of THA was associated with higher PJI revision rates at 90 days and 2 years (all P < .046). Stroke within 18 months increased PJI revision risk across all time points (all P < .047). Several risk factors were associated with this complication, including hypertension, obesity, and tobacco use. Stroke 6 to 18 months before THA was associated with higher rates of 90-day complications, including deep vein thrombosis, cardiac arrest, and surgical site infections. Patients with stroke prior to THA had significant risks of revision for PJI and aseptic revisions at 1 and 2 years, with risks depending on time between stroke and THA (all P < .002).
A history of stroke increases postoperative complications after THA, particularly PJI. We recommend patients defer THA for at least 18 months following a stroke to minimize risks.
Authors
Botolin Botolin, Robles Robles, Keshishian Keshishian, Bains Bains, Delanois Delanois, Patel Patel
View on Pubmed