Metabolic syndrome in total hip arthroplasty patients was associated with higher odds of 90-day surgical site infection (OR 2.41), periprosthetic joint infection, and all-cause revision.
Cohort (n=706,602)
Yes
Does metabolic syndrome increase the risk of postoperative complications in patients undergoing total hip arthroplasty?
Metabolic syndrome is significantly associated with increased odds of infectious, mechanical, and thromboembolic complications up to two years following total hip arthroplasty.
Effect estimate: OR 2.41
BACKGROUND Metabolic syndrome (MetS), a cluster of interrelated metabolic abnormalities typically including obesity, dyslipidemia, diabetes, and hypertension, has been linked to surgical complications, but its impact on total hip arthroplasty (THA) beyond 90 days is unclear. This study compared 90-day, one-year, and two-year THA outcomes in patients who had and did not have MetS, and identified which component of MetS (i.e., diabetes, hypertension, obesity, or hypertriglyceridemia) was most strongly associated with each complication. Outcomes included a) infectious (surgical site infection SSI; 90-day, periprosthetic joint infection PJI), b) mechanical (mechanical loosening, periprosthetic fracture PPFx), c) all-cause revision ACR, and d) deep vein thrombosis DVT; 90-day. METHODS A nationwide database identified 706,602 THA patients (21.0% MetS) from 2010 to 2023. Outcomes were evaluated at 90 days, one year, and two years. Unadjusted comparisons used Pearson's Chi-square and Student's t-tests; multivariable logistic regressions calculated odds ratios (OR) with 95% confidence intervals. RESULTS Higher 90-day SSI (OR 2.41) and PJI at 90 days and at one and two years (OR 1.58, 1.44, and 1.31) were associated with MetS. Obesity was most strongly associated with infection (SSI OR 2.45; PJI OR 1.73 to 1.87), followed by diabetes (SSI OR 1.58; PJI OR 1.47 to 1.60) and hypertension (PJI OR 1.47 to 1.50). Odds of PPFx were higher at all timepoints (OR 3.35, 3.10, and 2.86) most strongly associated with hypertriglyceridemia (OR 1.27 to 1.28) and diabetes (OR 1.21 to 1.25). Odds of ACR increased (OR 2.08, 1.81, and 1.66) and were associated with hypertension (OR 1.35 to 1.41) and obesity at 90 days (OR 1.11). Increased 90-day DVT (OR 3.52) was associated with hypertension, diabetes, and obesity (OR 1.59, 1.34, and 1.31). CONCLUSION Metabolic syndrome was associated with higher odds of infection, PPFx, ACR, and DVT, suggesting that this population may benefit from focused perioperative risk assessment and optimization.
Smitterberg et al. (Thu,) conducted a cohort in Total hip arthroplasty (n=706,602). Metabolic syndrome vs. No metabolic syndrome was evaluated on 90-day surgical site infection (SSI) (OR 2.41). Metabolic syndrome in total hip arthroplasty patients was associated with higher odds of 90-day surgical site infection (OR 2.41), periprosthetic joint infection, and all-cause revision.