Nonalcoholic Fatty Liver Disease is Not Associated with Elevated Risks of Surgical Complications at 2 Years Following Total Hip Arthroplasty: A Retrospective Cohort Study

Aim and background: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the world.This study investigated the effects of NAFLD on the incidence of surgical complications following total hip arthroplasty (THA).Materials and methods: A total of 6,21,037 patients receiving THA were identified from the PearlDiver database.Total hip arthroplasty patients with baseline NAFLD (n = 9,897) were 1:2 propensity score matched to controls (n = 19,472).Logistic regressions and Chi-square tests assessed the relationship between NAFLD and the incidence of periprosthetic fracture (PPF), revision, periprosthetic joint infection (PJI), prosthesis dislocation, and aseptic loosening at 2 years after THA.Results: Patients who had NAFLD experienced a lower incidence of all-cause revision at 2 years when compared to controls (2.2 vs 2.6%, p = 0.045).Logistic regression demonstrated a significant association between NAFLD and lower revision risk.No other significant differences emerged.Conclusion: Nonalcoholic fatty liver disease patients are not at elevated risk of revision or other implant-related complications in the first 2 years following THA.This is contrary to known relationships between cirrhosis and THA outcomes.Further research should be conducted to identify the specific stage in the progression of liver disease at which a patient transitions to an elevated risk of complications after THA.Clinical significance: These findings suggest that NAFLD alone should not be considered an independent risk factor for implant-related complications within 2 years after THA, helping clinicians distinguish the perioperative risk profile of NAFLD from that of more advanced liver disease.