Restless Legs Syndrome Is Associated With Higher Rates of Dislocation After Total Hip Arthroplasty

Restless legs syndrome (RLS) is a neurological disorder that induces involuntary leg movements that may hinder compliance with postoperative hip precautions; however, its impact on total hip arthroplasty (THA) outcomes has yet to be investigated. This study seeks to evaluate the influence of RLS on THA by comparing complication rates between patients who have RLS and a propensity-matched control cohort.

A retrospective analysis using a national database was conducted to identify patients who had a history of RLS who underwent THA between 2009 and 2022. This RLS cohort was propensity matched with a control cohort who did not have a history of RLS, and the rates of postoperative complications were identified. After propensity score matching, 3,204 RLS patients were identified per cohort. Absolute risks and odds ratios (ORs) were calculated for both study groups.

Our analysis demonstrated a higher risk of dislocation (OR: 1.64, P = 0.043), emergency department utilization (OR: 1.19, P = 0.027), and a decreased risk of readmission (OR: 0.63, P = 0.001) in patients who had RLS within 90 days postoperatively than in those who did not have RLS. At two years, the incidence of aseptic loosening was 3.3% in the RLS cohort and 2.4% in the non-RLS cohort (OR: 1.37, P = 0.036). Similarly, the incidence of periprosthetic joint infection was 2.5% in the RLS cohort and 1.8% in the non-RLS cohort (OR: 1.42, P = 0.045).

Restless legs syndrome was associated with a greater risk of periprosthetic dislocation and emergency department utilization, but a decreased readmission rate within 90 days of surgery, whereas aseptic loosening and periprosthetic joint infection were at greater risk at 2-year follow-ups compared to the propensity-matched control cohort. These findings suggest a clinically relevant association that offers the opportunity to mitigate these complications through targeted interventions.