Peripheral Artery Disease Is Associated With Increased Complications Following Primary Total Hip Arthroplasty
In brief
Peripheral artery disease nearly quadruples amputation risk after hip replacement
In a matched analysis of 5,552 hip-replacement patients with peripheral artery disease, the odds of any lower-extremity amputation were almost four times higher than in those without PAD. PAD also raised early infection, transfusion and revision rates, and increased three-year mortality, highlighting the need for vascular optimization before elective THA.
- Journal
- The Journal of arthroplasty (Q1)
- Published
- 15 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Sri Tummala, Tarun R Sontam, Dharani Rohit Thota, Angel A Valencia, Garen Collett, Antonia F Chen
- PMID
- 42744005
- DOI
- 10.1016/j.arth.2026.09.005
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 18 September 2026): PAD associated with increased complications after primary THA
Abstract
BACKGROUND: The presence of peripheral artery disease (PAD) may compromise outcomes following total hip arthroplasty (THA), yet its specific impact remains understudied. This study evaluated the association between PAD and outcomes following primary THA. METHODS: Leveraging a multinational healthcare database (2015 to 2025), 181,464 primary THA patients were identified. Cohorts were stratified by documented PAD diagnosis within one year before undergoing THA. A 1:1 propensity-score matching balanced 22 covariates, yielding 5,552 comparable pairs. Major medical and surgical complications were assessed 90 days and three years postoperatively. Analyses employed bivariable (RR) and multivariable (aHR) Cox models, reporting 95% confidence intervals (CI); significance was defined as P < 0.05. RESULTS: The PAD patients had significantly higher 30-day risks of surgical site infection (SSI; RR 1.86, P = 0.006), transfusion (RR 1.43, P < 0.001), anemia (RR 1.33, P = 0.002), and periprosthetic joint infection (PJI; RR 1.93, P = 0.007). At 90 days, PAD was additionally associated with wound dehiscence (RR 1.69, P = 0.004), persistently elevated SSI (RR 1.53, P = 0.009), and PJI risk (RR 1.79, P < 0.001). At 3-year follow-up, THA patients who had PAD had significantly higher revision rates (RR 1.39, P = 0.004), recurrent periprosthetic joint infection (RR 1.61, P < 0.001), and all-cause mortality (RR 1.43, P < 0.001) compared to patients who did not have PAD. Notably, PAD was associated with a near four-fold increased hazard of lower extremity amputation at any level (aHR 3.68, log-rank P < 0.0001; absolute risk 1.29 versus 0.35%). CONCLUSION: Given the considerable impact of PAD on THA outcomes, particularly catastrophic limb loss, comprehensive management strategies are crucial to mitigate adverse events. These findings underscore the need for risk stratification and targeted interventions, including vascular optimization and patient counseling, to improve outcomes following THA in this high-risk population. LEVEL OF EVIDENCE: Therapeutic Level III, Retrospective Cohort Study.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.