Metabolic Syndrome Is Associated With Higher Odds of Postoperative Complications After Total Hip Arthroplasty

Metabolic syndrome (MetS), a cluster of interrelated metabolic abnormalities typically including obesity, dyslipidemia, diabetes, and hypertension, has been linked to surgical complications, but its impact on total hip arthroplasty (THA) beyond 90 days is unclear. This study compared 90-days, 1-year, and 2-year THA outcomes in patients who had and did not have MetS, and identified which component of MetS (i.e., diabetes, hypertension, obesity, or hypertriglyceridemia) was most strongly associated with each complication. Outcomes included (1) infectious (surgical site infection [SSI; 90-days], periprosthetic joint infection [PJI]), (2) mechanical (mechanical loosening, periprosthetic fracture [PPFx]), (3) all-cause revision (ACR), and (4) deep vein thrombosis (DVT; 90-days).

A nationwide database identified 706,602 THA patients (21.0% MetS) from 2010 to 2023. Outcomes were evaluated at 90 days, 1 year, and 2 years. Unadjusted comparisons used Pearson Chi-square and Student's t-tests; multivariable logistic regressions calculated odds ratios (ORs) with 95% confidence intervals.

Higher 90-day SSI (OR 2.41) and PJI at 90 days and at one and two years (OR 1.58, 1.44, and 1.31) were associated with MetS. Obesity was most strongly associated with infection (SSI OR 2.45; PJI OR 1.73 to 1.87), followed by diabetes (SSI OR 1.58; PJI OR 1.47 to 1.60) and hypertension (PJI OR 1.47 to 1.50). Odds of PPFx were higher at all time points (OR 3.35, 3.10, and 2.86), most strongly associated with hypertriglyceridemia (OR 1.27 to 1.28) and diabetes (OR 1.21 to 1.25). Odds of ACR increased (OR 2.08, 1.81, and 1.66) and were associated with hypertension (OR 1.35 to 1.41) and obesity at 90 days (OR 1.11). Increased 90-day DVT (OR 3.52) was associated with hypertension, diabetes, and obesity (OR 1.59, 1.34, and 1.31).

Metabolic syndrome was associated with higher odds of infection, PPFx, ACR, and DVT, suggesting that this population may benefit from focused perioperative risk assessment and optimization.