• Seung-Beom Han, Jung-Ro Yoon, Ji-Young Cheong, Jun-Hoe Song, Jae-Doo Yoo, and Young-Soo Shin.
• Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
• Arch Orthop Trauma Surg. 2022 Sep 1; 142 (9): 2335-2348.

PurposeThis study aims to investigate the incidence rate and risk factors of stroke in patients treated with bilateral TKA compared with patients with unilateral TKA.MethodsIn this retrospective nationwide cohort study, we compared patients undergoing unilateral TKA or bilateral TKA using data from the Korean National Health Insurance claims database between January 1, 2009 and August 31, 2017 and included patients older than 40 years of age who underwent primary TKA by the index date as documented primary diagnosis and first additional diagnosis without a history of stroke during the preceding 1 year. We used matched Cox regression models to compare the incidence rate and risk factors of newly acquired stroke among patients treated with unilateral TKA or bilateral TKA after propensity score (PS) matching.ResultsIn the present study, 163,719 patients who received unilateral TKA were matched to 163,719 patients with bilateral TKA based on PS. The risk of stroke during the study period was lower in patients treated with bilateral TKA than in patients with unilateral TKA (adjusted hazard ratio [HR] 0.79). Patients who received bilateral TKA were at decreased risk of stroke when the following variables were present: advanced age (70-79 years, HR 0.76), female sex (HR 0.75), rural area (HR 0.77), small- or medium-sized hospital (HR 0.75), health insurance (HR 0.77), history of hypertension drug use (HR 0.75), congestive heart failure (HR 0.70), connective tissue disease (HR 0.71), diabetes (HR 0.77), and diabetes with complication (HR 0.76).ConclusionThe risk of stroke was lower in patients treated with bilateral TKA than in patients with unilateral TKA. Patients treated with bilateral TKA were at decreased risk of stroke when the following variables were present: age (70-79 years), female sex, health insurance, history of hypertension drug use, and comorbidities, such as congestive heart failure, connective tissue disease, and diabetes.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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