Background: Total knee arthroplasty (TKA) is primarily preformed among the elderly population who is commonly affected by cardiovascular and cerebrovascular diseases. Atrial fibrillation (AF) is a very common heart disease and its prevalence increases significantly with age. Therefore, we decided to evaluate the outcomes of patients with AF following TKA and analyze the risk factors of AF patients who underwent postoperative complication. Methods: We designed a retrospective cohort study using data from three institutions in China. We evaluated a total of 453 AF patients who received primary TKA and 453 matched control patients. Comparisons of specific parameters between AF and non-AF cohorts were performed. Results: Our results demonstrated that AF patients had significantly higher odds of more intraoperative bleeding, periprosthetic joint infection (PJI), post-operative cerebral stroke (POCS), post-operative cardiovascular events (POCE) and worse SF-36 physical component score and mental score at mean 24-month after surgery, but had no increased incidence of post-operative gastrointestinal events, DVT and PE in comparison to patients without AF than those without AF disease. Additionally, multivariate logistic regression analysis was used to identify risk factors of patients who underwent severe complication. Smoking, diabetes mellitus and persistent AF were common risk factors of PJI, POCS, and POCE. Heart rate> 70/min and absence of Beta blocker use were common risk factors of POCS and POCE. Absence of LMWH bridging was risk factor of POCS. BMI > 25 kg/m2 and hypertension were risk factors of POCE. Conclusions: These findings should be taken into consideration when discussing the expected outcomes of AF patients after TKA. AF disease impaired SF-36 physical component score (PCS) and mental component score (MCS) of patient after TKA. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.