Does Multiple Sclerosis Affect the Inpatient Perioperative Outcomes After Total Hip Arthroplasty? Jared M. Newman, MD a , Qais Naziri, MD b , Morad Chughtai, MD a , Anton Khlopas, MD a , Thomas J. Kryzak, MD a , Suparna M. Navale, MS, MPH c , Carlos A. Higuera, MD a , Michael A. Mont, MD a, * a Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio b Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York c Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio article info Article history: Received 15 April 2017 Received in revised form 30 June 2017 Accepted 5 July 2017 Available online xxx Keywords: total hip arthroplasty multiple sclerosis complications length of stay discharge disposition abstract Background: There is a paucity of studies evaluating the short-term perioperative outcomes of total hip arthroplasty (THA) in multiple sclerosis (MS) patients. Therefore, this study evaluated (1) patient factors; and (2) patient outcomes in MS THA patients compared to non-MS THA patients. Methods: The Nationwide Inpatient Sample from 2002 to 2013 identified 5899 MS and 2,723,652 non- MS THA patients. Yearly trends, demographics, and comorbidities were compared, and then non-MS THA patients were matched (3:1) to MS THA patients by age, gender, race, comorbidity score, and sur- gery year. Regression analyses compared perioperative complications (any, surgical, medical), length of stay (LOS), and discharge dispositions. Results: The annual prevalence of MS in THA patients increased from 1.36 per 1000 THAs in 2002 to 2.54 per 1000 THAs in 2013 (P ¼ .004). MS patients were younger, more likely female, take corticosteroids, have hip osteonecrosis, and have gait abnormalities. Compared to matched cohort, MS patients had a higher risk of any surgical (odds ratio [OR] ¼ 1.18; 95% confidence interval [95% CI], 1.02-1.37) and any medical (OR ¼ 1.55; 95% CI, 1.34-1.81) complications, an 8.24% longer mean LOS (95% CI, 5.61-10.94; <0.0001) and were more likely to be discharged to a care facility (OR ¼ 2.09; 95% CI, 1.82-2.40). Conclusion: Orthopedic surgeons should be cognizant of the potential increased risks after THA in MS patients. Neurologists and other practitioners may help optimize and enhance the preoperative care of potential THA candidates, and provide guidance as to the appropriate timing of intervention for hip issues in MS patients. © 2017 Elsevier Inc. All rights reserved. Given the widespread use of total hip arthroplasty (THA), it is inevitable that patients with relatively uncommon diseases will undergo THA. One such disease, multiple sclerosis (MS), is an autoimmune inflammatory disorder that affects the myelin sheath of axons in the central nervous system, resulting in demyelination [1,2]. While the etiology is not well understood, it is likely due to a combination of genetic and environmental components [2,3]. In the United States, there are approximately 400,000 people living with MS [2], with an overall prevalence of approximately 150 per 100,000 individuals [4]. Additionally, females are more commonly affected [2,5], and the onset usually occurs between the third and the fifth decades [2]. The prevalence of osteoarthritis (OA) in MS patients has been reported to be comparable to the general population [6,7]; moreover, MS patients have a higher risk of osteonecrosis of the femoral head [8e10]. Therefore, MS patients may be a part of the increasing annual population of patients who undergo THA [11]. MS is typically characterized by a number of symptomatic re- lapsing episodes followed by periods of recovery, which tend to be progressive and often results in disabling, permanent neurologic dysfunction [1,2,12,13]. Patients who have MS can experience various symptoms, including musculoskeletal problems, such as muscle spasticity, which has been reported to occur in 60%-90% [14e16]. Additionally, they may also experience paresis, tremors, weakness, impaired mobility, and gait disturbances [1,14,17]. One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.07.006. * Reprint requests: Michael A. Mont, MD, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195. Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org http://dx.doi.org/10.1016/j.arth.2017.07.006 0883-5403/© 2017 Elsevier Inc. All rights reserved. The Journal of Arthroplasty xxx (2017) 1e6