Acute stroke after total joint arthroplasty: a population-based trend analysis
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Updated: Mar 14, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Mohammad R Rasouli1, Reza Mostafavi Tabatabaee1, Mitchell G Maltenfort1
1Investigation performed at the Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA.
Study Objectives:
This study aims to determine trends and predictors of acute stroke among total joint arthroplasty (TJA) patients using nationally representative data.
Design:
Retrospective database review.
Setting:
Nationwide Inpatient Sample database.
Patients:
A total of 1,762,496 TJAs from 2002 to 2011.
Interventions:
Patients underwent primary or revision total hip or total knee arthroplasty.
Measurements:
Development of perioperative acute stroke.
Main Results:
Among 1,762,496 TJAs, 2414 patients (0.14%) developed stroke; 1918 (79.45%) cases were ischemic and the remaining 496 (20.55%) cases were hemorrhagic stroke. The incidence of stroke decreased steadily from 0.17% in 2002 to 0.14% in 2011, which was statistically significant (P<.0001). The in-hospital mortality rate was much higher after stroke at 9% vs 0.15% for general TJA patients. Logistic regression analysis showed that stroke is a strong predictor of in-hospital mortality (odds ratio [OR], 27.73; 95% confidence interval [CI], 23.06-33.05; P<.001). Independent predictors of stroke were presence of pulmonary circulation disorders (including pulmonary embolism; OR, 2.23; 95% CI, 1.73-2.87), advanced diabetes mellitus (OR, 2.10; 95% CI, 1.61-2.73), cardiac arrhythmia (OR, 2.05; 95% CI, 1.83-2.29), peripheral vascular disease (OR, 1.74; 95% CI, 1.42-2.12), valvular heart disease (OR, 1.67; 95% CI, 1.43-1.95), renal disease (OR, 1.66; 95% CI, 1.38-1.99), and revision hip (OR, 1.39; 95% CI, 1.18-1.65). History of stroke or ischemic heart disease was not an independent predictor of stroke.
Conclusions:
Despite a decline in the rate of stroke and stroke-related mortality after TJA, stroke still seems to be a major cause of in-hospital mortality. The present study outlines some risk factors for stroke after TJA. Recognition of these factors and identification of the at-risk patients may allow for appropriate allocation of resources and ability to minimize this complication after TJA.
