Complication profiles after total hip arthroplasty in non-cirrhotic NAFLD versus cirrhotic patients: A national matched cohort comparison

Introduction

Rising obesity has led to a surge in non-alcoholic fatty liver disease (NAFLD), now the most common chronic liver disease in the U.S. As obesity is also a major risk factor for osteoarthritis, orthopedic surgeons increasingly encounter patients with hepatic dysfunction undergoing joint replacement. While the surgical risks of cirrhosis are well-documented, direct comparisons between NAFLD and non-alcoholic cirrhosis in the context of total hip arthroplasty (THA) remain limited. This study compares postoperative outcomes following THA in matched cohorts with NAFLD versus cirrhosis.

Methods

A retrospective cohort analysis was conducted using the Mariner M170Ortho database (PearlDiver Technologies). From an initial pool of 1,864,381 patients who underwent primary THA between 2010 and 2020, individuals with NAFLD or non-alcoholic cirrhosis were identified using validated ICD-9 and ICD-10 codes. Following application of inclusion criteria and continuous enrollment filters, 1:1 propensity score matching was performed based on demographics and major comorbidities. The final matched cohort included 6,828 patients (3,414 NAFLD; 3,414 cirrhosis). Multivariable logistic regression models were constructed to compare postoperative outcomes, controlling for age, sex, and Charlson Comorbidity Index (CCI).

Results

At 90 days, cirrhotic patients experienced significantly higher rates of pulmonary embolism, hematoma, transfusion, acute kidney injury, and hospital readmission. The composite complication rate was also significantly elevated. At 1 year, these trends persisted, with significantly higher rates of pulmonary embolism, hematoma, transfusion, acute kidney injury, and readmission, along with increased overall complication rates.

Conclusion

Compared to patients with NAFLD, those with non-alcoholic cirrhosis undergoing THA are at significantly increased risk for multiple postoperative complications within both 90-day and 1-year intervals. These findings underscore the need for heightened perioperative vigilance and tailored risk stratification in cirrhotic patients undergoing lower extremity arthroplasty.