Osteosarcopenia as a predictor of inferior patient-reported outcomes following total hip arthroplasty in older adults: a propensity score-matched analysis

Abstract Background: Total hip arthroplasty (THA) is an effective surgical option for older adults (aged ≥65 years) with advanced hip osteoarthritis. However, functional recovery and patient satisfaction remain variable despite technical success. Osteosarcopenia—the coexistence of osteoporosis and sarcopenia—reportedly contributes to suboptimal postoperative outcomes due to its association with frailty, falls, and impaired physical function. Aims:To investigate whether osteosarcopenia independently predicts poorer patient-reported outcomes in older adults undergoing elective THA. Methods: We retrospectively analysed 214 patients (mean age: 73.8 ± 6.8 years) who underwent unilateral primary THA, with a mean follow-up of 42 (range 24–66) months. Osteoporosis was defined by lumbar spine T-score <−2.5. Sarcopenia was assessed using psoas muscle index (PMI), a validated measure correlating with EWGSOP2 criteria. Patients were categorised into four groups: osteosarcopenia (13%), sarcopenia-only (32%), osteoporosis-only (22%), and normal (33%). The primary outcome was achieving the minimum clinically important difference (MCID), defined as the smallest change in score that patients perceive as beneficial, using the Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR). Propensity score matching compared osteosarcopenia (n = 25) and control (n = 50) groups, adjusting for age, sex, body mass index, and comorbidities. Results: Osteoporosis and sarcopenia reduced likelihood of achieving MCID (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.60–0.83 and OR 0.79, 95%CI 0.64–0.97, respectively; both P < 0.05). Patients with osteosarcopenia had significantly lower HOOS-JR (P < 0.001), EuroQol-5D (P = 0.029) and satisfaction levels (P < 0.001) than controls. Preoperative PMI and nutritional status were correlated with final outcomes. Conclusions: Osteosarcopenia independently predicts inferior functional outcomes after THA in older adults. Preoperative screening for this geriatric syndrome should be incorporated into assessment protocols, as it may help guide personalised perioperative interventions, including nutritional support and adapted rehabilitation, thus enhancing recovery.