Neurologic and psychiatric disorders as risk factors following hip arthroplasty: results from the German arthroplasty registry.

PURPOSE

We investigated whether neurologic and psychiatric disorders (ICD-10 F00-F99, G00-G99) increase postoperative complications and mortality after hip arthroplasty and identified subgroups with distinct complication patterns, including dislocations, loosening, fractures, and elevated mortality.

METHODS

We analyzed 190,340 primary cementless hip arthroplasties from the German Arthroplasty Registry (2012-2024). Patients with relevant diagnoses were compared to matched controls (1:1 Mahalanobis distance) across subgroups F00-F99 and G00-G99, adjusting for age, sex, BMI, Elixhauser Index, and arthroplasty type. Primary endpoints were implant survival (time to revision) and all-cause mortality over up to eight years. Revision causes including periprosthetic fracture, infection, dislocation, loosening, and others were systematically recorded.

RESULTS

Most subgroups showed significantly higher revision rates (p < 0.0001 for F00-F09, F10-F19, F30-F39, G20-G26, G40-G47, G60-G64). Mortality was also significantly higher (p < 0.0001 for F00-F09, F10-F19, F30-F39). Schizophrenia (F20-F29) increased revision (p < 0.0001) and mortality (p < 0.0001). Organic mental disorders (F00-F09) showed markedly elevated revision and mortality rates, with more frequent dislocations and fractures (p < 0.0001). Extrapyramidal disorders (G20-G26) mainly increased dislocation risk (p = 0.00032), while degenerative diseases (G30-G32) raised mortality (p < 0.0001). Episodic/paroxysmal disorders (G40-G47) increased loosening (p = 0.0041) and revision (p < 0.0001). Polyneuropathies (G60-G64) were linked to joint instability and dislocations (p = 0.0008).

CONCLUSION

Neurologic and psychiatric disorders significantly elevate revision and mortality risks following hip arthroplasty. Subgroup-specific vulnerabilities, dislocations/fractures (F00-F09), high complication and mortality (F10-F19), and joint instability (G60-G64), highlight the need for individualized perioperative strategies and close postoperative monitoring to improve outcomes.