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Usage of Loop Diuretics for Hypertension is Associated With Increased Complications Following Total Hip Arthroplasty

Jackson W Durbin1, Amy Y Zhao1,2, Eric Cui1

  • 1Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Arthroplasty Today
|April 24, 2026
PubMed

Insights

Diuretic use, particularly loop diuretics, is linked to increased risks of revision surgery and complications like periprostastic fractures after total hip arthroplasty (THA). These findings suggest a potential impact of common hypertension medications on THA outcomes.

Area of Science:

  • Orthopedic Surgery
  • Pharmacology
  • Biomaterials Science

Background:

  • Diuretics are frequently prescribed for hypertension in patients undergoing total hip arthroplasty (THA).
  • The influence of diuretics on bone metabolism and remodeling, and their subsequent effect on THA outcomes, is not well understood.
  • This study investigates the association between diuretic use and implant-related complications within two years of THA.

Purpose of the Study:

  • To evaluate the impact of diuretic use on the incidence of implant-related complications following total hip arthroplasty (THA).
  • To compare revision rates and specific complications (loosening, periprosthetic fracture) between THA patients using diuretics and those who are not.

Main Methods:

  • Retrospective analysis of a national administrative claims database.
  • Inclusion of patients undergoing primary total hip arthroplasty (THA).
  • Comparison of patients on loop diuretics, thiazides, or combination therapy against non-diuretic users, using multivariable logistic regression to assess 2-year outcomes.

Main Results:

  • A significant proportion (27.1%) of THA patients used diuretics pre-surgery.
  • Diuretic use was associated with higher odds of all-cause revision: thiazides (OR: 1.1), loop diuretics (OR: 1.5), and combination therapy (OR: 1.9).
  • Loop diuretics and combination therapy increased the risk of periprosthetic fracture (PPF)-related revision, while loop diuretics were linked to higher odds of revision due to mechanical loosening.

Conclusions:

  • Loop diuretic use correlates with increased odds of adverse 2-year implant-related outcomes, including PPF, mechanical loosening, and all-cause revision.
  • Thiazide use also showed a modest increase in revision risk.
  • Further research is necessary to establish causality and elucidate the mechanisms linking diuretic use to THA complications.
Abstract

Keywords:
DiureticsImplant revisionMechanical looseningPeriprosthetic fractureTotal hip arthroplasty

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