Elective Total Hip Arthroplasty in Parkinson’s Disease: Increased 90-Day Readmission and Early Procedural Escalation

Background Patients with Parkinson’s disease (PD) undergoing total hip arthroplasty (THA) may be at increased risk for postoperative complications due to neuromuscular dysfunction and medical frailty. Contemporary national data on short-term outcomes following elective primary THA in this population remain limited. This study evaluated index hospitalization complications and 90-day readmission with procedural escalation after elective primary THA in patients with PD. Methods We performed a retrospective cohort study using the Nationwide Readmissions Database (2020–2022). Adult patients undergoing elective primary THA on hospital day 0 were identified. A 1:5 propensity score-matched cohort was constructed using demographics, payer, hospital characteristics, calendar year, and comorbidities (all standardized mean differences < 0.1). Index complications, 90-day readmission, and readmission-associated procedural escalation (any procedure, reoperation, and revision) were assessed. Results The matched cohort included 12,143 elective primary THAs (2,043 PD; 10,100 controls). PD was associated with higher rates of perioperative complications, including blood transfusion, pneumonia, urinary tract infection, and hip dislocation (all p ≤ 0.015), while in-hospital mortality remained low and similar between groups. Within 90 days, PD patients had higher readmission (10.3% vs 5.8%; OR 1.86; p < 0.001) and markedly increased procedural escalation, including reoperation (3.3% vs 0.9%) and revision (3.0% vs 0.7%) (all p < 0.001). Length of stay was longer in PD patients, with no significant difference in hospital charges. Conclusions Elective primary THA in patients with Parkinson’s disease is associated with increased perioperative complications and substantially higher 90-day readmission with early revision and reoperation. These findings highlight increased post-discharge vulnerability in this population and underscore the need for enhanced perioperative optimization and postoperative surveillance. Levels of Evidence: Level III