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Does Atrial Septal Defect Increase the Risk of Stroke Following Total Hip and Knee Arthroplasty?

Morad Chughtai1, Dean C Perfetti2, Anton Khlopas1

  • 1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

Surgical Technology International
|January 9, 2018
PubMed

Insights

Patients with atrial septal defect (ASD) have a significantly higher risk of stroke after hip or knee replacement surgery. This highlights the need for careful preoperative assessment and risk discussion for these individuals.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Orthopaedic Surgery

Background:

  • Atrial septal defect (ASD) is a congenital heart condition linked to paradoxical emboli.
  • Patients with ASD undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) face potential risks.

Purpose of the Study:

  • To determine the prevalence of ASD in patients undergoing primary THA/TKA.
  • To evaluate the risk of stroke in patients with ASD following these procedures.

Main Methods:

  • Utilized the New York Statewide Planning and Research Cooperative System for data from 2005-2014.
  • Analyzed 258,911 primary THA/TKA cases, including 140 with ASD.
  • Employed logistic regression to calculate stroke risk, controlling for confounding factors.

Main Results:

  • ASD prevalence was 54 per 100,000 THA/TKA patients.
  • Postoperative stroke rate within 30 days was 5.7% for ASD patients versus 0.1% for others.
  • Patients with ASD had a 70-fold increased odds of stroke (OR: 70.0, 95% CI: 32.9-148.9).

Conclusions:

  • Patients with ASD are at a substantially elevated risk of postoperative stroke after THA and TKA.
  • Awareness and discussion of these risks are crucial for surgeons and internists during preoperative clearance.
  • Further research is needed to explore interventions for reducing stroke risk in this population.
Abstract

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