title: Head computed tomography is not useful for evaluating patients change in mental status following total joint arthroplasty.
abstract: We retrospectively reviewed 187 patients who presented with neurologic abnormality after total joint arthroplasty to establish the incidence of diagnosed organic brain disorders in these patients and determine the utility of advanced head imaging studies. 139 of 187 (74.3%) patients underwent imaging for altered mental status (AMS) and 48 patients for a focal neurologic deficit (FND). Acute findings on head imaging were more common in the FND group. The incidence of stroke and transient ischemic attack was significantly lower in the AMS group compared to FND group (Stroke: 0% vs 12.5%, p < 0.001; TIA: 0% vs. 16.7%, P < .001). Advanced head imaging for evaluation of TJA patients with a change in mental status is of low yield. An algorithm for evaluation of these patients is proposed.
authors: Thomas Jefferson University Department of Orthopaedic Surgery, Philadelphia, Pennsylvania.
authors: Justin C
authors: JC
authors: Wong
authors: Anderson Orthopaedic Research Institute and the Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, Virginia.
authors: Nitin
authors: N
authors: Goyal
authors: Department of Neurology, Cerebrovascular Division at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors: William C
authors: WC
authors: McBride
authors: The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors: Matthew S
authors: MS
authors: Austin
authors: The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors: Gregory K
authors: GK
authors: Deirmengian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D001927:Brain Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003244:Consciousness Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: brain MRI; head computed tomography; mental status change; stroke