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Perioperative Stroke Rare but Deadly in Joint Replacement

Non-coronary heart disease, urgent surgery, general anesthesia, arrhythmia among risk factors

THURSDAY, Sept. 9 (HealthDay News) -- Though rare, perioperative stroke following joint replacement has a high rate of both mortality and morbidity, according to a study in the Sept. 1 issue of the Journal of Bone & Joint Surgery.

S.M. Javad Mortazavi, M.D., of the Thomas Jefferson University Hospital in Philadelphia, and colleagues evaluated 18,745 patients who underwent hip or knee total arthroplasty during 2000 to 2007. The researchers followed the patients for perioperative stroke incidence, and determined patient- and surgery-related factors affecting the incidence and outcomes.

The rate of perioperative stroke in the cohort was 0.2 percent (36 patients), and first-year mortality among those stroke patients was 25 percent (nine patients, four of whom died in the hospital following arthroplasty). Of the three patients who received emergency intra-arterial thrombolysis, two recovered completely neurologically and one died. The researchers found the following significant independent risk factors for perioperative stroke in arthroplasty patients: history of non-coronary heart disease, urgent (versus elective) surgery, general (versus local) anesthesia, and intraoperative arrhythmia or other heart rate alterations during surgery.

"Perioperative stroke is a rare but potentially devastating complication of total joint arthroplasty, with a high rate of morbidity and mortality. Vigilant attention to prevent, detect, and treat this complication in a timely manner may alter the course of the disease," the authors write.

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