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Background <p>As the global population ages, total hip arthroplasty (THA) is increasingly performed in elderly patients who are vulnerable to perioperative complications. However, data on the short-term burden and predictors of such complications in real-world cohorts remain limited.</p> Methods <p>We retrospectively analyzed patients aged ≥ 70&#xa0;years who underwent elective primary THA between January 2021 and December 2024. Postoperative complications within 90&#xa0;days were identified and categorized. Propensity score matching (PSM, 1:1) was applied based on age, sex, and BMI, and univariate logistic regression was used to assess perioperative risk factors.</p> Results <p>Among 310 patients (mean age 77.1 ± 3.4&#xa0;years; 68.7% female), 106 (34.2%) experienced at least one postoperative complication within 90&#xa0;days. The most common events were pulmonary infection (7.1%), urinary tract infection (4.2%), surgical site infection (3.2%), delirium (2.9%), and deep vein thrombosis (2.9%). After PSM, 196 patients were included (98 with and 98 without complications). Logistic regression identified delayed ambulation (OR 3.13, 95% CI 1.59–6.15), preoperative hypoalbuminemia (OR 2.72), blood loss ≥ 500&#xa0;mL (OR 2.34), intraoperative transfusion (OR 2.25), preoperative anemia (OR 2.15), and Charlson comorbidity index ≥ 3 (OR 1.88) as significant predictors (all <i>P</i> &lt; 0.05).</p> Conclusion <p>Postoperative complications were common in elderly THA patients, primarily infectious or functional. Clinical frailty and perioperative factors including nutritional deficits, blood loss, and delayed mobilization significantly increased risk. Early identification and optimization of these factors may help reduce postoperative morbidity in older surgical candidates.</p>

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Postoperative Complications and Associated Risk Factors Following Total Hip Arthroplasty in Elderly Patients: A Propensity Score–Matched Retrospective Cohort Study

  • 期刊论文

  • 发表日期：

    2026年2月4日

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  • Menghang Wu,
  • Gang Xie,
  • Mingqing Peng

摘要

Background

As the global population ages, total hip arthroplasty (THA) is increasingly performed in elderly patients who are vulnerable to perioperative complications. However, data on the short-term burden and predictors of such complications in real-world cohorts remain limited.

Methods

We retrospectively analyzed patients aged ≥ 70 years who underwent elective primary THA between January 2021 and December 2024. Postoperative complications within 90 days were identified and categorized. Propensity score matching (PSM, 1:1) was applied based on age, sex, and BMI, and univariate logistic regression was used to assess perioperative risk factors.

Results

Among 310 patients (mean age 77.1 ± 3.4 years; 68.7% female), 106 (34.2%) experienced at least one postoperative complication within 90 days. The most common events were pulmonary infection (7.1%), urinary tract infection (4.2%), surgical site infection (3.2%), delirium (2.9%), and deep vein thrombosis (2.9%). After PSM, 196 patients were included (98 with and 98 without complications). Logistic regression identified delayed ambulation (OR 3.13, 95% CI 1.59–6.15), preoperative hypoalbuminemia (OR 2.72), blood loss ≥ 500 mL (OR 2.34), intraoperative transfusion (OR 2.25), preoperative anemia (OR 2.15), and Charlson comorbidity index ≥ 3 (OR 1.88) as significant predictors (all P < 0.05).

Conclusion

Postoperative complications were common in elderly THA patients, primarily infectious or functional. Clinical frailty and perioperative factors including nutritional deficits, blood loss, and delayed mobilization significantly increased risk. Early identification and optimization of these factors may help reduce postoperative morbidity in older surgical candidates.