Impact of Stroke History and Interval on Outcomes of Total Hip Arthroplasty: A Retrospective Cohort Study.

Stroke within 6 months of THA was associated with higher periprosthetic joint infection (PJI) revision rates at 90 days and 2 years.

• All P < .046 for PJI revision rates at 90 days and 2 years in the stroke-within-6-months cohort
• The stroke-within-6-months cohort included n = 5,535 patients
• Comparisons were made against a no-stroke cohort of n = 20,000 patients

Stroke within 18 months of THA increased PJI revision risk across all time points (90 days, 1 year, and 2 years).

• All P < .047 for PJI revision risk across all time points in patients with stroke within 18 months
• The stroke-within-18-months cohort included n = 2,614 patients
• This finding spanned all three follow-up intervals assessed: 90 days, 1 year, and 2 years

Stroke occurring 6 to 18 months before THA was associated with higher rates of specific 90-day complications including deep vein thrombosis, cardiac arrest, and surgical site infections.

• The 6-to-18-month interval was identified as a period of elevated risk for multiple complication types
• Specific complications included deep vein thrombosis, cardiac arrest, and surgical site infections at the 90-day time point
• Cohorts in this interval ranged from n = 3,165 (12 months) to n = 2,614 (18 months)

Patients with prior stroke 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 for revision for PJI and aseptic revisions at 1 and 2 years
• Risk magnitude varied based on the interval between stroke and THA surgery
• Both septic (PJI) and aseptic revision endpoints were significantly affected

Several patient-level risk factors were identified as associated with PJI following THA in patients with prior stroke, including hypertension, obesity, and tobacco use.

• Risk factors were identified via multivariate analysis
• Hypertension, obesity, and tobacco use were among the identified risk factors for PJI
• The total study cohort included 35,496 THA patients stratified across six groups by stroke timing

The study stratified 35,496 THA patients into six cohorts based on time from stroke to surgery.

• Cohorts were: 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)
• Data were drawn from a national database analyzed retrospectively
• Complication rates were compared at 90 days, 1 year, and 2 years postoperatively

The authors recommend deferring THA for at least 18 months following a stroke to minimize postoperative risks.

• This recommendation is based on findings that stroke within 18 months increased PJI revision risk across all time points
• The recommendation addresses both infectious (PJI) and non-infectious complications
• Prior literature on perioperative management of stroke patients undergoing THA was described as limited