title: Cognitive dysfunction after total knee arthroplasty: effects of intraoperative cerebral embolization and postoperative complications.
abstract: Cerebral emboli identified as high-intensity transient signals (HITS) occur during total knee arthroplasty (TKA). Their effects on cognitive outcome remain speculative. Intraoperative HITS and postoperative complications were correlated with the cognitive function of TKA patients. Cognitive function was assessed both before and after surgery (1 week and 3 months). High-intensity transient signals occurred in 22 of 37 patients. Counts of HITSs were higher in patients with sonographically detected intracardiac shunts. Cognitive dysfunction was found in 41% of patients at 1 week, but in only 18% at 3 months. High-intensity transient signal counts were not associated with the prevalence of cognitive deficits. At 1 week, 58% of patients with cognitive deficits had at least 1 postoperative complication (6% in nondeficit patients). All cognitively impaired patients at 3 months had complications (17% in the nondeficit group). This raises the possibility that postoperative complications might be associated with cognitive dysfunction in TKA patients.
authors.affiliation: Cardiac Division, Department of Anesthesia, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Rosendo A
authors.initials: RA
authors.lastname: Rodriguez
authors.forename: Andrée
authors.initials: A
authors.lastname: Tellier
authors.forename: Jenny
authors.initials: J
authors.lastname: Grabowski
authors.forename: Anna
authors.initials: A
authors.lastname: Fazekas
authors.forename: Michelle
authors.initials: M
authors.lastname: Turek
authors.forename: Donald
authors.initials: D
authors.lastname: Miller
authors.forename: Christopher
authors.initials: C
authors.lastname: Wherrett
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Villeneuve
authors.forename: Alan
authors.initials: A
authors.lastname: Giachino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D016896:Treatment Outcome