Postoperative Sleep Disorders in Elderly THA Patients: Phenotypes, Risk Factors, and Perioperative Rehabilitation Strategies: A Single-Center Retrospective Observational Study

Purpose Sleep disorder is a frequent postoperative complication after total hip arthroplasty (THA). This study aimed to characterize sleep disorder phenotypes, identify associated risk factors, and explore the relationships between sleep disturbance patterns and clinical outcomes in elderly patients aged ≥70 years. Materials and Methods A single-center retrospective analysis included 892 primary THA patients between January 2021 and December 2024. Sleep disorders were assessed via a validated 12-item questionnaire and diagnosed according to the International Classification of Sleep Disorders, 2nd Edition. Visual analog scale (VAS) pain scores and length of hospital stay (LOS) were extracted and stratified by different groups. All patients finished a minimum 6-month postoperative follow-up. Results 78.3% of patients had postoperative sleep disturbances (median 6 weeks, range 4-8 weeks). Primary insomnias (72.1%) dominated, with adjustment sleep disorder (41.5%) most common; secondary insomnias (27.9%) linked to comorbidities (19.7%) and drugs (8.2%). Elderly patients had 83.5% incidence and 3.2-fold higher risk of persistent disturbances versus non-elderly patients ( p <0.001). Patients with sleep maintenance difficulties or non-restorative sleep tended to present with higher VAS ( p <0.001) and longer LOS ( p <0.001) significantly. Discussion Pain (38.6%), psychological stress (29.4%), and intrinsic factors (16.2%) were most commonly associated with sleep disturbances. Elderly patients were more vulnerable to comorbidity-related and environmental sleep disruptors. Differences in clinical indicators were observed between patients receiving personalized perioperative management and those under routine care. Conclusions Adjustment sleep disorder is the most common postoperative sleep phenotype in THA patients. Pain, psychological factors, and intrinsic characteristics are key drivers. In addition, patients with difficulty in staying asleep and non-restorative sleep are associated with higher pain scores and prolonged LOS. Elderly patients are high-risk for persistent sleep disturbances and inferior recovery outcomes. These findings suggest potential directions for patient-centered perioperative management, while relevant associations need further verification.