Correlation of Hypertension With Adverse Outcomes Following Total Hip Arthroplasty: A Matched Cohort Analysis

Introduction: Total hip arthroplasty (THA) is a widely performed procedure. Despite its overall success, adverse outcomes have been associated with defined comorbidities. Hypertension (HTN), which affects a notable portion of the adult population, may be one such factor but has not been independently studied in this regard. Methods: THA patients were abstracted from the 2010 to 2022 M165 Ortho PearlDiver Mariner Database. Adult patients with versus without HTN were matched 1:1 based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse outcomes and 5-year implant survival rates were compared for the matched cohorts with multivariable analysis, adjusting for multiple comparisons. Results: Of 851,605 THA patients identified, HTN was noted for 601,475 (70.6%). After matching, there were 148,946 patients with and the same number without HTN. Patients with HTN were at independently greater odds of most individual adverse outcomes assessed, any adverse events (odds ratio OR 2.18), serious adverse events (OR 2.19), minor adverse events (OR 2.26), and readmissions (OR 1.52) ( P < 0.001 for each). Furthermore, the 5-year implant survival rate was mildly lower in HTN group (96.5% versus 97.5%, P < 0.001). Discussion: The current, large-cohort study identified HTN to be diagnosed for more than half of patients undergoing THA. The clear correlation of HTN with many adverse outcomes and mildly (but statistically) lower 5-year implant survival highlights the need for further consideration of this variable. Although there could be other confounding factors that may not have been fully controlled, those with HTN are clearly an “at-risk” group.