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J Arthroplasty. 2014 Jun;29(6):1114-8. doi: 10.1016/j.arth.2013.12.030. Epub 2013 Dec 28.

Head computed tomography is not useful for evaluating patients change in mental status following total joint arthroplasty.

Author information

  • 1Thomas Jefferson University Department of Orthopaedic Surgery, Philadelphia, Pennsylvania.
  • 2Anderson Orthopaedic Research Institute and the Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, Virginia.
  • 3Department of Neurology, Cerebrovascular Division at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
  • 4The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.


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.

Copyright © 2014 Elsevier Inc. All rights reserved.


brain MRI; head computed tomography; mental status change; stroke

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