Postoperative Complications Following Total Hip Arthroplasty: A Retrospective Analysis

Background: Total hip arthroplasty (THA) is among the most frequently performed orthopedic procedures worldwide, providing substantial improvements in pain relief and functional restoration for patients with endstage hip joint disease. Despite significant advances in surgical techniques, implant technology, and perioperative care protocols, postoperative complications remain a considerable clinical concern affecting patient outcomes, healthcare utilization, and long-term prosthetic survivorship. Comprehensive characterization of complication patterns and their associated risk factors is essential for optimizing patient selection and perioperative management strategies. Methods: This retrospective cohort study analyzed medical records of 712 consecutive patients who underwent primary THA at a tertiary orthopedic center. Demographic variables, surgical parameters, comorbidity profiles, and postoperative complications occurring within 90 days and one year were systematically documented. Univariate and multivariable logistic regression analyses were performed to identify independent risk factors associated with overall and specific complications. Results: The overall 90-day complication rate was 14.3% (n = 102), while the one-year complication rate was 18.8% (n = 134). The most frequent complications included periprosthetic joint infection (PJI; 2.9%), venous thromboembolism (VTE; 3.4%), dislocation (3.1%), and periprosthetic fracture (1.8%). Independent risk factors for overall complications included age ≥75 years (OR: 2.14; 95% CI: 1.38–3.32; p = 0.001), BMI ≥35 kg/m² (OR: 2.47; 95% CI: 1.51–4.04; p < 0.001), diabetes mellitus (OR: 1.89; 95% CI: 1.19–3.01; p = 0.007), ASA classification ≥III (OR: 2.08; 95% CI: 1.32–3.28; p = 0.002), and operative time exceeding 120 minutes (OR: 1.76; 95% CI: 1.12–2.78; p = 0.015). Conclusion: Postoperative complications following primary THA occur in a clinically significant proportion of patients. Modifiable risk factors including obesity and prolonged operative time, alongside non-modifiable factors such as advanced age and comorbidity burden, significantly predict adverse outcomes. Targeted perioperative optimization strategies may reduce complication rates and improve overall surgical outcomes.