Does Osteonecrosis of the Femoral Head Increase Early Complication Rates After Total Hip Arthroplasty? A Japanese Nationwide Medical Claims Database Study

Background: Osteonecrosis of the femoral head (ONFH) and osteoarthritis (OA) are two common diagnoses for patients undergoing total hip arthroplasty (THA). The early surgical complications in THA for ONFH compared to OA are inconsistently reported. Therefore, this study aimed to evaluate whether THA for ONFH was associated with early postoperative complications in comparison to THA for OA using a large database of Japanese patients. Methods: In this cohort study, using a Japanese national medical claims database on ONFH and OA patients undergoing THA from December 2011 to March 2023, we assessed the surgical-related complications, medical complications, and mortality during hospitalization after propensity score matching by age, sex, body mass index, and comorbidities. A total of 24,326 pairs of THAs for ONFH and OA were included. Results: In the THA for ONFH group, the odds ratios for various complications were as follows: dislocation (1.3, 95% CI [confidence interval]: 1.1 to 1.6, P < 0.01), infection (1.0, 95% CI: 0.8 to 1.2, P = 0.94), periprosthetic fracture (1.0, 95% CI: 0.8 to 1.4, P = 0.86), nerve palsy during hospitalization (0.4, 95% CI: 0.2 to 0.9, P = 0.034), pneumonia (1.7, 95% CI: 1.1 to 2.5, P < 0.01), deep vein thrombosis (0.9, 95% CI: 0.8 to 1.0, P = 0.018), pulmonary embolism (1.5, 95% CI: 0.9 to 2.5, P = 0.14), cardiac events (0.7, 95% CI: 0.3 to 2.1, P = 0.55), cerebrovascular events (0.7, 95% CI: 0.5 to 1.0, P = 0.084), acute renal failure (1.4, 95% CI: 0.4 to 4.4, P = 0.56), and mortality during hospitalization (1.8, 95% CI: 1.3 to 2.4, P < 0.01). Conclusions: These findings contribute to identifying postoperative risks for ONFH patients and suggest that more attention should be paid to preoperative planning and postoperative care for ONFH patients.