Sarcopenia Is Associated with an Increased Risk of Postoperative Complications Following Total Hip Arthroplasty for Osteoarthritis

Simple Summary Sarcopenia is an age-related disease characterized by uncontrolled muscle wasting and weakness in geriatric populations. Similarly, osteoarthritis is a prevalent condition involving irreversible joint damage. Late-stage osteoarthritis of the hip often requires surgical treatment with total hip replacement. Unfortunately, it is not uncommon for patients presenting for total hip replacement to also have underlying sarcopenia. Given the role of sarcopenia in musculoskeletal biology, as well as overall health, sarcopenia may affect the recovery and success of operations. However, the impact of sarcopenia on total hip replacement outcomes has not been well-defined. We have shown, in this study, that a diagnosis of sarcopenia prior to total hip replacement surgery is associated with significantly poorer postoperative outcomes as well as greater costs of care. This study identified an important risk factor for orthopedic surgeons to consider when treating elderly patients for late-stage osteoarthritis. Considering the postoperative risks, orthopedic surgeons may potentially opt to treat or reduce the severity of sarcopenia prior to surgery. Sarcopenia is a state of catabolic muscle wasting prevalent in geriatric patients. Likewise, osteoarthritis is an age-related musculoskeletal disease affecting patients with similar demographics. Late-stage hip osteoarthritis is often treated with total hip arthroplasty (THA). As sarcopenia influences the surgical outcomes, this study aimed to assess the impact of sarcopenia on the outcomes of THA. A 1:3 matched case-control study of sarcopenic to control patients was performed using a large national database. In total, 3992 patients were analyzed. Sarcopenic patients undergoing THA were more likely to experience dislocation (odds ratio (OR) = 2.19, 95% confidence interval (CI) 1.21-3.91) within 1 year of THA. Furthermore, sarcopenic patients had higher urinary tract infection rates (OR = 1.79, CI 1.32-2.42) and a greater risk of 90-day hospital readmission (hazard ratio (HR) = 1.39, CI 1.10-1.77). Sarcopenic patients experienced more falls (OR = 1.62, CI 1.10-2.39) and fragility fractures (OR = 1.77, CI 1.34-2.31). Similarly, sarcopenic patients had higher day of surgery costs (USD 13,534 vs. USD 10,504) and 90-day costs (USD 17,139 vs. USD 13,394) compared with the controls. Ultimately, sarcopenic patients undergoing THA experience higher rates of postoperative complications and incur greater medical costs. Given the potential risks, orthopedic surgeons may consider treating or reducing the severity of sarcopenia before surgery.

Automated summary

Sarcopenia prior to total hip replacement surgery is associated with significantly poorer postoperative outcomes as well as greater costs of care. Orthopedic surgeons should consider treating or reducing the severity of sarcopenia before surgery for elderly patients with late-stage osteoarthritis.