神経因性膀胱が股関節全置換術の転帰に与える影響の評価：マッチドコホート分析

Total hip arthroplasty (THA) alleviates pain and improves mobility in individuals with end-stage hip disease. However, THA patients with neuropathic bladder may face increased postoperative risks. This study aimed to assess how neuropathic bladder conditions influence outcomes after primary THA and propose recommendations to avoid associated complications.

A retrospective cohort analysis was conducted using data from TriNetX Research Network, including 193,988 patients aged 18 years and older who underwent primary THA between January 1, 2003, and January 1, 2020. Patients were categorized into two cohorts: those with (NB) and without (no-NB) neuropathic bladder conditions prior to THA. Propensity score matching yielded 1482 patients in each cohort. Rates of postoperative outcomes at 30 days, 90 days, 1 year, and 5 years were compared.

Within 30 days of surgery, NB patients demonstrated significantly elevated rates of urinary tract infection, pneumonia, periprosthetic joint infection (PJI), deep vein thrombosis, and transfusion compared to no-NB patients (P < 0.01). Similar trends continued at 90 days post-THA, with the NB cohort also showing a higher risk of pulmonary embolism and acute renal failure (P < 0.01). Furthermore, the NB cohort faced increased risks of PJI over a 1-year period (risk ratio (RR): 1.8; 95 % confidence intervals (CI): 1.3, 2.4) and revision arthroplasty over a 5-year period (RR: 2.6; CI: 1.8, 3.8) compared to the no-NB cohort.

Patients with neuropathic bladder undergoing THA faced significantly elevated risks of postoperative complications, highlighting the need for tailored postoperative management strategies of neuropathic bladder to mitigate these risks and improve THA outcomes.