A History of Preoperative Falls is Associated with Increased Risk of Postoperative Medical and Surgical Complications Following Total Hip Arthroplasty:A Propensity-Matched Analysis.

Abstract

Falls are common among older adults and reflect multisystem vulnerability that may predispose patients to adverse surgical outcomes. Although traditional preoperative risk factors for complications following total hip arthroplasty (THA) are well established, the independent prognostic value of a preoperative fall history remains poorly defined. This study aimed to evaluate whether a documented preoperative history of falls was associated with an increased risk of postoperative complications following primary THA in older adults. Patients who were 65 years or older and underwent primary THA between January 1, 2005, and December 31, 2023, were identified within a large national database. Patients were stratified by the presence of a documented fall within the year preceding surgery. A 1:1 propensity score match was performed for age, sex, race, body mass index, and major comorbidities. After matching, 7,360 patients remained in each cohort, with balanced baseline characteristics. Within 90 days, the preoperative falls cohort experienced greater readmission, emergency department utilization, wound disruption, acute kidney injury, sepsis, pneumonia, myocardial infarction, and postoperative falls (P < 0.05). At one year, patients who had a preoperative fall experienced greater revision (3.4 versus 1.7%; relative risk (RR), 1.95), periprosthetic fracture (2.2 versus 1.1%; RR, 2.11), periprosthetic joint infection (1.6 versus 1.1%; RR, 1.48), dislocation (2.4 versus 1.0%; RR, 2.33), aseptic loosening (0.7 versus 0.4%; RR, 1.64), and mortality (0.4 versus 0.2%; RR, 2.46). These associations persisted at two years (P < 0.05). Postoperative falls were more frequent at one (9.5 versus 4.0%; P < 0.001) and two years (16.6 versus 7.3%; P < 0.001) among patients who had a preoperative fall. A documented preoperative history of falls is independently associated with higher risks of medical morbidity, postoperative falls, surgical complications, and mortality following THA in older adults. Routine preoperative fall risk assessment may enhance risk stratification and identify patients who may benefit from targeted prehabilitation and perioperative optimization.