TJA Patients With Hx of Stroke: Higher Mortality at 5 Years?

What might be the situation with patients who have had a cerebrovascular accident, or stroke, are left with ongoing neurological deficits and need total joint arthroplasty? This is what a team from Mayo Clinic in Rochester, Minnesota and Mayo Clinic in Jacksonville, Florida set out to discover.

Their work, “What are the Outcomes After Primary Total Hip and Knee Arthroplasty in Patients With Prior Cerebrovascular Accidents?” appears in the July 6, 2022 edition of The Journal of Arthroplasty.

Cameron K. Ledford, M.D., a consultant in the Department of Orthopedic Surgery at Mayo Clinic in Florida, was a co-author on the study. Dr. Ledford commented to OTW, “Cerebrovascular accidents, or strokes, are a major cause of disability worldwide, particularly as early recognition and treatment has led to improved survivorship of these patients. Subsequently, aging stroke survivors may develop hip and knee degenerative joint disease and it’s important to better understand the outcomes of total hip (THA) and knee arthroplasty (TKA) in this unique cohort.”

“Previous studies have evaluated the risk of postoperative stroke but to the authors’ knowledge, the outcomes of cerebrovascular accident patients undergoing THA or TKA had not been described.”

The team investigated the postoperative mortality rate of patients who had prior cerebrovascular accident sequelae, whether these patients have higher rates of any revision, any reoperation, or any complications, including postoperative cerebrovascular accident, and whether a previous cerebrovascular accident sequelae compromised clinical outcomes after THA and TKA.

Making use of the Mayo Clinic total joint registry, the researchers considered patients who had cerebrovascular accident sequelae and underwent primary THA or TKA between January 1, 2008 and December 31, 2018.

When looking at 5-year survivorship after THA, the team found that for patients with cerebrovascular accident sequelae it was 69%; for the non-cerebrovascular accident patients, it was 89%. After TKA, 5-year survivorship for the cerebrovascular accident sequelae group was 56% versus 90% in the non-cerebrovascular accident sequelae group.

“Compared to a matched set of patients without history of stroke,” stated Dr. Ledford to OTW, “cerebrovascular accident patients have similarly good outcomes after THA and TKA without increased risk of complication, including the risk of postoperative cerebrovascular accident. However, these patients have higher mortality rates at five years.”

“These data should help guide surgeons in their preoperative discussions of risk and benefits of elective total hip or knee arthroplasty in cerebrovascular accident patients. Additionally, we would recommend perioperative evaluation and management with a multidisciplinary team, including neurology, for patients with history of stroke.”