Peripheral Artery Disease Is Associated With Increased Complications Following Primary Total Hip Arthroplasty.

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.