Diabetic Neuropathy Is Associated With Increased Orthopaedic and Medical Complications After Total Hip Arthroplasty

Diabetes affects over 38 million people in the United States, and diabetic neuropathy (DN) is a common complication associated with adverse musculoskeletal and vascular effects. Despite its prevalence, the impact of DN on outcomes following total hip arthroplasty (THA) remains poorly defined. This study evaluated the effect of DN on postoperative outcomes after THA compared with nondiabetic patients and patients who had diabetes without neuropathy.

A retrospective cohort study was conducted using a large national database in the years 2005 to 2022. Adults undergoing primary THA were categorized into three groups: nondiabetic patients, patients who have diabetes without neuropathy (diabetes mellitus [DM]), and patients who have DN. Outcomes included 2-year orthopaedic complications, including periprosthetic joint infection, implant failure, periprosthetic fracture, and revision; and 90-day medical complications. Propensity score matching (1:1) controlled for age, sex, comorbidity burden, and hemoglobin A1c. The study cohort consisted of 193,483 patients: 151,427 nondiabetic patients, 31,915 patients who have diabetes without neuropathy, and 10,141 patients who have DN.

After matching, compared with DM, DN was associated with higher risks of postoperative joint infection (relative risk [RR] 1.57, 95% confidence interval [CI] 1.34 to 1.84), implant complications (RR 1.54, 95% CI 1.34 to 1.78), and revision surgery (RR 1.21, 95% CI 1.01 to 1.43). Patients who had DN also demonstrated increased 90-day risks of pneumonia and wound disruption compared with both DM and nondiabetic cohorts. In contrast, DM showed no increased orthopaedic risk compared with nondiabetic patients.

Diabetic neuropathy was independently associated with increased orthopaedic complications following THA, even after adjusting for glycemic control and comorbidity burden. These findings identify DN as an important driver of postoperative risk and support incorporating neuropathy assessment into preoperative risk stratification. These findings support incorporating neuropathy assessment into preoperative risk stratification and perioperative management.