Patients with neuropathic bladder (NB), a condition in which nerve damage affects bladder function, have a significantly higher risk of joint infections, blood clots, and other adverse events after receiving total hip replacement (THR), UT Southwestern Medical Center researchers found.
“Many neuropathic bladder patients don’t understand the gravity of their condition or tell their surgeons about it,” said Senthil Sambandam, M.D., Associate Professor of Orthopaedic Surgery at UT Southwestern and senior author of the study published in the Journal of Orthopaedics. “As surgeons, we must be more aware of bladder issues because patients with NB can require significant postoperative resources.”
Dr. Sambandam decided to study the incidence of post-surgery complications after questioning whether NB was affecting outcomes for hip replacement patients in his surgical practice.
Neuropathic bladder is a condition in which damage to the brain or spinal cord interferes with bladder control. The condition can be caused by diabetic neuropathy, spinal trauma, stroke, Parkinson’s disease, multiple sclerosis, and other neurologic disorders. Patients may require catheterization to drain their bladders, and some use diapers due to incontinence.
To track post-surgical complications in NB patients, UT Southwestern researchers used the TriNetX Research Network, an electronic health record data set from more than 80 U.S. health care organizations. They identified 1,428 NB patients within the network and compared their incidence of post-surgery complications with a set of non-NB patients.
Neuropathic bladders that fail to completely drain can allow urinary tract infections (UTIs) to flourish, and catheters can further introduce pathogens. The researchers found that, due to frequent catheter use, patients with NB were 3.8 times more likely to experience UTIs 30 and 90 days after THR than those with fully functioning bladders.
UTI pathogens can travel through the bloodstream and cause infections elsewhere. NB patients were 1.8 times more likely to experience joint replacement infections than patients without NB within one year of surgery. Chronic inflammation can also weaken the immune systems of NB patients, making them three times more likely to contract pneumonia within 30 and 90 days of their hip replacements, also known as total hip arthroplasty (THA).
Greater risk of joint infections, hip dislocations, and fractures made patients with NB more than twice as likely to undergo revision surgery to repair replaced hips at one and five years after surgery.
UTSW researchers discovered NB patients were also twice as likely to develop life-threatening blood clots, also known as deep vein thrombosis, in their lower extremities.
“These elevated risks persist even after matching patients for age, sex, body mass index, smoking status, and diabetes, indicating neuropathic bladder itself is an independent risk factor,” said Antonia Chen, M.D., M.B.A., Chair and Professor of Orthopaedic Surgery and study co-author. “Patients may need counseling on the impacts of neuropathic bladder on their hip replacement outcomes.”
Dr. Sambandam recommended that surgeons remain alert for neurological conditions affecting patients’ bladders and suggested performing THRs in settings with multidisciplinary support teams to handle their complex cases. Proper catheter maintenance to prevent UTIs, a healthy immune system to prevent complications such as pneumonia, and prophylaxis to prevent deep vein thrombosis may inhibit THR complications.
More research is necessary to determine which NB patients carry the greatest risk for complications after total hip replacement and to develop further preventive methods.
More information
James Hwang et al, Assessing the impact of neuropathic bladder on total hip arthroplasty outcomes: A matched cohort analysis, Journal of Orthopaedics (2026). DOI: 10.1016/j.jor.2025.12.001
Clinical categories
The content is provided for information purposes only.