Long-term risk of all-cause mortality and major adverse cardiovascular events in hip osteoarthritis patients after total hip replacement

Introduction

To evaluate the long-term effects of total hip replacement (THR) on all-cause mortality and major adverse cardiovascular events (MACEs) among patients with hip osteoarthritis (OA).

Methods

A retrospective cohort study utilizing data from the TriNetX US Collaborative Network, a multicenter electronic health record database. We identified adult patients diagnosed with hip OA between January 1, 2012, and December 31, 2020. Propensity score matching (PSM) was employed to generate 16,893 matched pairs of patients who underwent THR and those who did not. Outcomes included all-cause mortality and incidence of MACEs, analyzed using Kaplan–Meier survival curves and Cox proportional hazards models. Subgroup analyses were conducted stratified by age, sex, race, and body mass index (BMI).

Results

Following PSM, patients receiving THR demonstrated a significantly 41 % lower risk of all-cause mortality (hazard ratio [HR], 0.59; 95 % confidence interval [CI], 0.54–0.64) and a 41 % lower risk of MACEs (HR, 0.59; 95 % CI, 0.56–0.62) compared with those not undergoing THR. Subgroup analysis revealed sex-based heterogeneity in mortality benefit (HR, 0.61; 95 % CI, 0.54–0.69 in males vs. HR, 0.75; 95 % CI, 0.66–0.87 in females). Age-stratified analyses for MACE risk showed a diminishing protective effect with increasing age (HR, 0.48 for 50–59 years; HR, 0.58 for 60–69 years; HR, 0.66 for 70–79 years).

Conclusions

Total hip replacement is associated with a substantial reduction in long-term all-cause mortality and cardiovascular events among patients with hip OA, corresponding to approximately 40 % lower risks compared with non-surgical patients. These associations appear to be modified by sex and age. The observed benefits may reflect improved mobility, enhanced physical activity, and better cardiovascular health following surgical intervention.