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Timing of stroke in patients undergoing total hip replacement and matched controls: a nationwide cohort study
Arief Lalmohamed1, Peter Vestergaard, Cyrus Cooper
1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Insights
Total hip replacement (THR) patients face a significantly higher risk of stroke within weeks of surgery. Early risk assessment and considering antiplatelet drugs may mitigate these risks.
Area of Science:
- Orthopedic Surgery
- Neurology
- Public Health
Background:
- Stroke is a serious complication following total hip replacement (THR).
- The timing of stroke post-THR and the impact of drug use were previously unclear.
- This study aimed to clarify stroke risk timing in THR patients.
Purpose of the Study:
- To determine the timing of stroke in patients undergoing total hip replacement (THR).
- To compare stroke risk in THR patients versus matched controls.
- To investigate the influence of drug use on stroke risk after THR.
Main Methods:
- Nationwide cohort study using Danish registers (1998-2007).
- Included 66,583 primary THR patients matched with controls.
- Time-dependent Cox models adjusted for medical history and drug use.
Main Results:
- A 4.7-fold increased risk of ischemic stroke and 4.4-fold risk of hemorrhagic stroke within 2 weeks post-THR.
- Elevated risk persisted for 6 weeks (ischemic) and 12 weeks (hemorrhagic).
- Antiplatelet drug use reduced ischemic stroke risk by 70% but did not affect hemorrhagic stroke risk.
Conclusions:
- THR patients experience a substantially increased risk of both ischemic and hemorrhagic stroke in the initial postoperative period.
- Stroke risk assessment for THR patients should extend for 6-12 weeks post-surgery.
- Considering antiplatelet therapy may be beneficial for reducing ischemic stroke risk.
Background And Purpose:
Stroke is a potentially fatal complication of total hip replacements (THR). However, timing of stroke in THR patients compared with matched controls and influence of drug use remain unknown. The objective of this study was to determine timing of stroke in patients with THR compared with matched control subjects.
Methods:
A nationwide cohort study was conducted within the Danish registers (1998-2007). Included patients were those with a primary THR in the study period (n=66,583) and were matched by age, sex, and region to three referent subjects without THR or total knee replacements. Time-dependent Cox models were used to derive hazard ratios and were adjusted for disease history and drug use.
Results:
A 4.7-fold increased risk of ischemic stroke (adjusted hazard ratio, 4.69; 95% CI, 3.12-7.06), and a 4.4-fold increased risk of hemorrhagic stroke (adjusted hazard ratio, 4.40; 95% CI, 2.01-9.62) were found within 2 weeks following THR, compared with matched controls. The risk remained elevated during the first 6 postoperative weeks for ischemic stroke, and the first 12 weeks for hemorrhagic stroke. Outpatient antiplatelet drug use lowered the 6-week hazard ratios for ischemic stroke by 70%, although not affecting risk of hemorrhagic stroke.
Conclusions:
This study shows, that THR patients have a 4.7-fold increased risk of ischemic stroke, and a 4.4-fold increased risk of hemorrhagic stroke during the first 2 weeks postsurgery. Risk assessment of stroke in individual patients undergoing THR (ie, evaluate other risk factors for stroke) should be considered during the first 6 to 12 weeks.
