After total hip arthroplasty, patients with glucocorticoid-treated osteonecrosis of the femoral head have a higher risk of in-hospital reoperation: a nationwide propensity score-matched analysis

PURPOSE: Inpatient glucocorticoid treatment has been associated with increased postoperative complications after total hip arthroplasty (THA). However, evidence specific to osteonecrosis of the femoral head (ONFH) remains limited and inconsistent. This study aimed to evaluate the association between inpatient glucocorticoid treatment and early postoperative complications after THA for ONFH using a nationwide database. METHODS: This retrospective cohort study used the Japanese Diagnosis Procedure Combination database from 2011 to 2023. Patients undergoing THA for ONFH were identified and categorized according to inpatient glucocorticoid treatment. Propensity score matching was performed using demographic and perioperative variables. The primary outcome was reoperation during hospitalization. Secondary outcomes included surgical and medical complications and in-hospital mortality. Multivariate logistic regression analysis was performed to identify independent risk factors. RESULTS: After propensity score matching, 19,154 patients were included. Inpatient glucocorticoid treatment was independently associated with an increased risk of reoperation (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.26-2.37; p < 0.001). No significant associations were observed between inpatient glucocorticoid treatment and dislocation (OR, 1.17; p = 0.45), surgical site infection (OR, 1.03; p = 0.86), periprosthetic fracture (OR, 1.38; p = 0.24), or in-hospital mortality (OR, 1.69; p = 0.35). Medical complications were also not significantly different between the groups. Closed reduction and revision arthroplasty were the most common reoperations in both groups. CONCLUSION: Patients receiving inpatient glucocorticoid treatment had a higher risk of reoperation after THA for ONFH, despite no significant increase in most early postoperative complications. These findings suggest that patients receiving inpatient glucocorticoid treatment may represent a medically vulnerable population at increased risk of early postoperative reoperation after THA. Careful perioperative management may be warranted in this high-risk population.