Does Traumatic Brain Injury Increase Surgical and Medical Complications After Total Hip Arthroplasty?

Traumatic brain injuries (TBIs) are a common neurological injury and can cause impaired cognition and fatigue. However, it is unknown how these systemic effects may influence surgical recovery following a total hip arthroplasty (THA). In this study, we asked whether a prior TBI was associated with a higher risk of postoperative medical and surgical complications.

Using a national claims database, we examined adult patients undergoing a primary THA, excluding those who had a hip infection, hip fracture, or incomplete demographic information. This resulted in 81,586 (10.5%) patients who had a prior TBI diagnosis and 697,562 (89.5%) patients who did not. We examined the incidence of postoperative complications, including revision surgery, acute kidney injury (AKI), pulmonary embolism (PE), pneumonia, and urinary tract infection (UTI). Multivariate regression models were used to assess the risk of 90- and 365-day complications based on prior TBI diagnosis.

We found that a prior diagnosis of a TBI was associated with greater rates of 90- and 365-day revision surgery and certain medical complications, including AKI, PE, pneumonia, and UTI (P < 0.05). In the multivariable regression analysis, the association between prior diagnosis of a TBI and greater risk of 90-day all-cause revision surgery persisted. This was greatest among patients who have a 1-year history of a TBI (odds ratio: 1.28; 95% confidence interval: 1.07 to 1.51; P = 0.005). For 365-day medical complications, prior TBI was associated with a greater risk of AKI, PE, pneumonia, and UTI (P < 0.05 for all).

Our findings highlight a prior TBI diagnosis as a potential risk factor for increased surgical and medical complications following a THA. Further research is needed to explore the impact of a TBI on the physiological post-THA state to inform preoperative interventions and reduce the risk of TBI-related adverse events.