JOA - 2026-09-15 - Journal Article
Peripheral Artery Disease Is Associated With Increased Complications Following Primary Total Hip Arthroplasty.
Tummala S, Sontam TR, Thota DR, Valencia AA, Collett G, Chen AF
Topics
Key Takeaway
PAD patients undergoing primary THA face a 3.68-fold increased hazard of lower extremity amputation and 39% higher 3-year revision rates compared to propensity-matched controls.
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Summary
This study used a multinational healthcare database (2015–2025) to determine whether PAD independently increases complication rates after primary THA, using 1:1 propensity-score matching on 22 covariates to yield 5,552 pairs. PAD was associated with significantly elevated 30-day risks of SSI (RR 1.86), PJI (RR 1.93), and transfusion (RR 1.43), with risks persisting at 90 days. At 3 years, PAD patients had higher revision rates (RR 1.39), recurrent PJI (RR 1.61), all-cause mortality (RR 1.43), and a near four-fold increased hazard of lower extremity amputation (aHR 3.68; absolute risk 1.29% vs. 0.35%).
Key Limitation
PAD severity is not captured; the cohort conflates mild claudication with critical limb ischemia, making it impossible to define a vascular threshold below which THA risk is acceptable.
Original Abstract
BACKGROUND
The presence of peripheral artery disease (PAD) may compromise outcomes following total hip arthroplasty (THA), yet its specific impact remains understudied. This study evaluated the association between PAD and outcomes following primary THA.
METHODS
Leveraging a multinational healthcare database (2015 to 2025), 181,464 primary THA patients were identified. Cohorts were stratified by documented PAD diagnosis within one year before undergoing THA. A 1:1 propensity-score matching balanced 22 covariates, yielding 5,552 comparable pairs. Major medical and surgical complications were assessed 90 days and three years postoperatively. Analyses employed bivariable (RR) and multivariable (aHR) Cox models, reporting 95% confidence intervals (CI); significance was defined as P < 0.05.
RESULTS
The PAD patients had significantly higher 30-day risks of surgical site infection (SSI; RR 1.86, P = 0.006), transfusion (RR 1.43, P < 0.001), anemia (RR 1.33, P = 0.002), and periprosthetic joint infection (PJI; RR 1.93, P = 0.007). At 90 days, PAD was additionally associated with wound dehiscence (RR 1.69, P = 0.004), persistently elevated SSI (RR 1.53, P = 0.009), and PJI risk (RR 1.79, P < 0.001). At 3-year follow-up, THA patients who had PAD had significantly higher revision rates (RR 1.39, P = 0.004), recurrent periprosthetic joint infection (RR 1.61, P < 0.001), and all-cause mortality (RR 1.43, P < 0.001) compared to patients who did not have PAD. Notably, PAD was associated with a near four-fold increased hazard of lower extremity amputation at any level (aHR 3.68, log-rank P < 0.0001; absolute risk 1.29 versus 0.35%).
CONCLUSION
Given the considerable impact of PAD on THA outcomes, particularly catastrophic limb loss, comprehensive management strategies are crucial to mitigate adverse events. These findings underscore the need for risk stratification and targeted interventions, including vascular optimization and patient counseling, to improve outcomes following THA in this high-risk population.
LEVEL OF EVIDENCE
Therapeutic Level III, Retrospective Cohort Study.