Compared To Osteoarthritis, Osteonecrosis Of Femoral Head tied To Higher Postoperative Risks Following Total Hip Arthroplasty: Study
Researchers have found in a new study that patients receiving total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) had higher risks for postoperative complications than those for osteoarthritis (OA). This was conducted by Hidetatsu T. and fellow researchers published in the Journal of Arthroplasty.
This cohort study investigated data from the Japanese national medical claims database in the period spanning from December 2011 through March 2023. With propensity score matching, patients underwent THA because of ONFH and OA who were matched up for age, sex, body mass index (BMI), and comorbidities. At the end of the analysis, a total of 24,326 matched pairs. The study assessed the risk of developing surgical complications (for example, dislocation, infection, or periprosthetic fracture), medical complications (for example, pneumonia, deep vein thrombosis, and cardiac events), and in-hospital mortality.
Results
Surgical Complications
Dislocation: ONFH patients were 1.3-fold increased risk than OA patients; (95% CI: 1.1–1.6, p< 0.01).
Infection: The risk was equivalent between groups; (OR: 1.0, 95% CI: 0.8–1.2, p= 0.94).
Periprosthetic fracture: Similar risk between ONFH and OA (OR: 1.0, 95% CI: 0.8–1.4, p=0.86).
Nerve palsy during hospital stay: Reduced risk in ONFH patients (OR: 0.4, 95% CI: 0.2–0.9, p=0.034).
Medical Complications:
Pneumonia: Risk was 1.7 times greater in ONFH patients (95% CI: 1.1–2.5, p< 0.01).
Deep vein thrombosis: Slightly reduced odds in ONFH patients (OR: 0.9, 95% CI: 0.8–1.0, p=0.018).
Pulmonary embolism: No significant difference (OR: 1.5, 95% CI: 0.9–2.5, p= 0.14).
Cardiac events: No significant difference (OR: 0.7, 95% CI: 0.3–2.1, p=0.55).
Cerebrovascular events: Marginally lower odds in ONFH patients (OR: 0.7, 95% CI: 0.5–1.0, p=0.084).
In-Hospital Mortality:
ONFH patients showed an 80% higher mortality risk (OR: 1.8, 95% CI: 1.3–2.4, p< 0.01).
Researchers concluded that ONFH patients who undergo THA are exposed to increased risks postoperatively, especially with regard to dislocation, pneumonia, and in-hospital mortality, compared to OA patients. These results bring out the significant need for personalized care strategies that can optimize surgical outcomes in ONFH patients.
Reference:
Tanaka, H., Tarasawa, K., Mori, Y., Kuriyama, Y., Kawamata, H., Fushimi, K., Fujimori, K., & Aizawa, T. (2025). Does osteonecrosis of the femoral head increase early complication rates after total hip arthroplasty? A Japanese nationwide medical claims database study. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2025.01.029
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