Wagener Nele, Grimberg Alexander, Wu Yinan, Hardt Sebastian, Perka Carsten
Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Endoprothesenregister Deutschland (EPRD), 10623, Berlin, Germany.
Int Orthop. 2025 Jun 26. doi: 10.1007/s00264-025-06593-2.
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.
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.
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).
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.
我们调查了神经和精神障碍（国际疾病分类第十版F00 - F99，G00 - G99）是否会增加髋关节置换术后的并发症和死亡率，并确定了具有不同并发症模式的亚组，包括脱位、松动、骨折和死亡率升高。
我们分析了来自德国关节置换登记处（2012 - 2024年）的190,340例初次非骨水泥型髋关节置换术。将患有相关诊断的患者与F00 - F99和G00 - G99亚组中匹配的对照组（1:1马氏距离）进行比较，并对年龄、性别、体重指数、埃利克斯豪泽指数和关节置换类型进行了调整。主要终点是植入物存活率（翻修时间）和长达八年的全因死亡率。系统记录了翻修原因，包括假体周围骨折、感染、脱位、松动等。
大多数亚组的翻修率显著更高（F00 - F09、F10 - F19、F30 - F39、G20 - G26、G40 - G47、G60 - G64，p < 0.0001）。死亡率也显著更高（F00 - F09、F10 - F19、F30 - F39，p < 0.0001）。精神分裂症（F20 - F29）增加了翻修率（p < 0.0001）和死亡率（p < 0.0001）。器质性精神障碍（F00 - F09）的翻修率和死亡率明显升高，脱位和骨折更频繁（p < 0.0001）。锥体外系疾病（G20 - G26）主要增加了脱位风险（p = 0.00032），而退行性疾病（G30 - G32）增加了死亡率（p < 0.0001）。发作性/阵发性疾病（G40 - G47）增加了松动率（p = 0.0041）和翻修率（p < 0.0001）。多发性神经病（G60 - G64）与关节不稳定和脱位有关（p = 0.0008）。
神经和精神障碍显著增加了髋关节置换术后的翻修和死亡风险。亚组特异性易感性、脱位/骨折（F00 - F09）、高并发症和死亡率（F10 - F19）以及关节不稳定（G60 - G64），突出了需要个性化的围手术期策略和密切的术后监测以改善预后。
