Associated factors of nerve injury post-total hip arthroplasty: a meta-analysis

Nerve injury is a rare complication following total hip arthroplasty (THA), but its management is highly difficult once it occurs. To reduce its incidence, deeply investigating its associated factors is of key significance. Therefore, the associated factors of nerve injury post-THA were analyzed and summarized in this meta-analysis by study screening and data processing.

We searched Embase, PubMed, Cochrane Library, and Web of Science up to April 28, 2025 for studies on the associated factors of nerve injury post-THA. We performed quality assessment using the Newcastle-Ottawa Scale and data analysis using Stata 15.0.

Twelve case-control studies involving 1,179,492 patients were finally included. Univariate analyses revealed that elevated odds of nerve injury post-THA had associations with younger age (< 50 years) [OR (95% CI) 1.73 (1.31, 2.28), P < 0.0001], obesity (BMI ≥ 28 kg/m² in this study) [OR (95% CI) 1.35 (1.16, 1.56), P < 0.0001], sex (female) [OR (95% CI) 1.33 (1.24, 1.43), P < 0.0001], fractures [OR (95% CI) 1.30 (1.08, 1.57), P = 0.006], operation time [SMD (95% CI) 0.37 (0.17, 0.58), P < 0.0001], revision surgery [OR (95% CI) 1.89 (1.31, 2.74), P = 0.001], and spinal diseases [OR (95% CI) 2.26 (1.79, 2.86), P < 0.0001]. Multivariate analyses showed that sex (female) [OR (95% CI) 1.22 (1.10, 1.35), P < 0.0001], posterolateral (PL) approach [OR (95% CI) 1.95 (1.35, 2.81), P < 0.0001] and spinal diseases [OR (95% CI) 2.60 (1.46, 4.62), P < 0.0001] were significantly associated with postoperative nerve injury.

Univariate analyses revealed that younger age (< 50 years), obesity, sex (female), fractures, longer operation time, revision surgery, and spinal diseases were all associated with increased odds of nerve injury post-THA. However, multivariate analyses showed that only sex (female), PL approach, and spinal diseases had significant associations with higher odds of nerve injury post-THA. No significant association with nerve injury was observed for osteoarthritis, rheumatoid arthritis, and diabetes. The leave-one-out sensitivity analysis in the spinal disease subgroup had limited robustness of results, while the results of multivariate sensitivity analysis were robust. Therefore, caution is warranted when interpreting the conclusions. Additionally, due to the limited data available for multivariate analysis in the included studies, great heterogeneity in some data, and the presence of multiple types of nerve injury, our findings should be interpreted cautiously.