Factors associated with constipation after total hip arthroplasty and nursing countermeasures

Abstract

The aim was to investigate the independent risk factors for constipation after total hip arthroplasty, according to which a nomogram prediction model was established to provide a basis for the prevention of postoperative constipation. The data of total hip replacement patients in our hospital were collected from January 2022 to December 2023, and the independent risk factors for postoperative constipation after total hip arthroplasty were determined by using unifactorial and multifactorial logistic regression analysis, and the corresponding nomogram was established. The receiver operating characteristic curves were plotted and the area under the curve was calculated, and the calibration curves and decision curves were plotted to evaluate the model performance. A total of 436 total hip replacement patients were enrolled in the study, and 314 post-total hip replacement patients developed constipation, with an incidence rate of 72.02%. This incidence rate was based on the correct number of constipation cases (314 out of 436), as verified after data revalidation. After univariate and multivariate logistic regression analyses, a total of 5 variables were identified as independent risk factors for constipation after total hip arthroplasty, namely age > 70 years (odds ratio [OR], 3.651; 95% confidence interval [CI], 1.678–5.843), irregular diet (OR, 3.074; 95% CI, 1.539–4.125), anxiety (OR, 3.123; 95% CI, 1.573–4.368), bedridden for >48 hours (OR, 5.244; 95% CI, 1.625–6.376), and history of constipation (OR, 6.190; 95% CI, 1.872–7.855). The nomogram of constipation after total hip arthroplasty constructed in this study has good predictive accuracy and helps physicians to intervene in advance in patients at high-risk of constipation after total hip arthroplasty.

1. Introduction

Hip arthroplasty, as an effective treatment for osteoarthritis of the hip and fracture of the neck of the femur,^[1] has been increasingly used in the elderly population against the background of an aging population and climbing obesity rates.^[2,3] However, postoperative constipation has become a significant problem affecting the quality of patients’ recovery. According to recent studies, the incidence of this complication has reached 80%, far exceeding previous reports of 65%, highlighting the importance of constipation in the management of postoperative hip arthroplasty.^[4,5] Constipation not only causes patients’ dietary discomfort, but also triggers anxiety, depression and other emotional disorders, and in severe cases, even induces complications such as intestinal obstruction, which directly leads to the obstruction of the rehabilitation process and an increase in hospitalization, thus affecting the overall efficacy of the surgery and the patient’s prognosis.^[6] Although the concept of accelerated rehabilitation is progressing, the mechanism of postoperative constipation after hip arthroplasty remains incompletely understood. Prolonged bed rest, which is common after hip arthroplasty, significantly reduces physical activity, leading to decreased gastrointestinal motility and slowed colonic transit time. Reduced abdominal pressure and limited mechanical stimulation of the intestines during immobilization further impair bowel movements. Meanwhile, a history of chronic constipation may predispose patients to postoperative bowel dysfunction by causing neuromuscular abnormalities and altered bowel habits, which complicate the recovery of normal intestinal function after surgery. Moreover, opioid analgesics commonly used for postoperative pain control can inhibit gastrointestinal nerve function, further delaying defecation. These factors may act synergistically, resulting in a high incidence of postoperative constipation in this patient population. Nomogram has been used in many fields, not only for hip dislocation after total hip arthroplasty,^[7] but also for the prediction of abnormal rattling after hip arthroplasty^[8] and postoperative delirium after hip arthroplasty,^[9] and all of them have achieved good prediction results. The aim of this study was to investigate the independent risk factors for constipation after total hip arthroplasty, and to establish a nomogram prediction model accordingly.

2. Materials and methods

2.1. Data sources and data collection

This study retrospectively analyzed the data of patients hospitalized for total hip replacement from January 2022 to December 2023 in our hospital. The study was retrospective and complied with the relevant standards of the Hospital Ethics Committee.

To ensure the consistency and accuracy of data abstraction, 2 trained researchers independently extracted clinical information from the hospital’s electronic medical records using a predefined standardized data collection form. All variables were defined prior to data collection. A third researcher subsequently reviewed the extracted data and resolved any discrepancies to ensure data quality.

2.2. Inclusion and exclusion criteria

Inclusion criteria: diagnosis were femoral neck fracture or hip arthritis; treated with total hip arthroplasty; complete clinical data. Exclusion criteria included: patients with constipation caused by specific organic diseases such as Parkinson’s disease, diabetic neuropathy, hypothyroidism, or spinal cord injury, as identified through discharge diagnoses and clinical notes in the medical records; patients taking medications known to cause constipation (e.g., opioids, antidepressants, calcium channel blockers), based on medication history recorded in the electronic medical records at admission or during hospitalization; and patients with diagnosed gastrointestinal tumors.

2.3. Diagnostic criteria

Reduced frequency of defecation (<3 times per week); dry and hard feces (refer to Bristol fecal typing standard, type 1 and type 2 indicate constipation, of which type 1 is granular and hard, and type 2 is sausage-like but with bumpy and rough surface); difficulty in defecation (including effort to defecate, difficulty in evacuating, feeling of incompleteness of defecation, time-consuming to defecate, and needing assistance in defecating by maneuvering); the degree of defecation difficulty is classified into 4 grades, grade III and above indicates that patients are suffering from constipation, and grade III and above indicates that patients have a combination of digestive tract tumors. The degree of defecation difficulty is categorized into 4 grades, grade III and above indicates constipation, that is, there is obvious feeling of falling, discomfort or frequent bowel movement, but defecation is difficult and small in amount, and abdominal pain or burning sensation in anus is less frequent. A diagnosis of constipation was made if the patient met more than one of the listed criteria.^[10] This approach was adapted from the Rome IV criteria and relevant domestic clinical guidelines. While some criteria (e.g., straining during defecation) may have higher specificity, others such as reduced frequency or hard stools are also clinically significant, especially in elderly postoperative patients with limited symptom expression. Given the retrospective nature of our study and possible incomplete documentation in some cases, we adopted a pragmatic threshold of “more than one” criterion to balance sensitivity and feasibility, and to reduce the risk of underestimation in this patient population.

2.4. Collection of relevant variables

During the exhaustive clinical assessment of patients undergoing total hip arthroplasty, a series of key data points were carefully collected to support the construction of a comprehensive patient portrait. This included recording their age to consider the impact of physiological stage, sex to analyze potential gender differences, body mass index to assess nutritional status versus surgical risk, and smoking and drinking habits to understand their potential impact on rehabilitation. Meanwhile, literacy reflects the possible role of educational level on health perception, disease type including arthritis and fractures, and spousal status and living conditions are examined to capture the patient’s social support system. The identification of dietary status and anxiety disorders helps to identify psychological and physiological factors that may affect postoperative recovery. In addition, time points such as time in bed, history of preoperative constipation, time of surgery, intraoperative bleeding, and time of urinary catheter removal were recorded to provide temporal clues for surgical management and postoperative care. Since this was a retrospective study, all variables were extracted from the hospital’s electronic medical record system. For missing data, complete case analysis was used. Patients with missing values for key variables were excluded from the analysis. The proportion of missing data was <5% and did not significantly affect the study results.

All variables were extracted from the hospital’s electronic medical record system. Anxiety status was determined based on nursing documentation and physician notes, in accordance with clinical impressions, rather than standardized scales. Dietary irregularity was defined as noncompliance with the hospital’s nutritional plan, such as meal skipping, low fiber intake, or reliance on semiliquid food. Postoperative constipation was diagnosed by nurses according to documented symptoms, including decreased bowel frequency, hard stool consistency, or straining, based on Rome IV criteria and modified clinical judgment.

Cases with missing data on key variables were excluded from the analysis (complete case analysis). The proportion of missing data was <5% for all variables, and imputation was not performed to avoid introducing bias in this retrospective study.

2.5. Statistical analysis

In R software (version 4.2.1; R Foundation for Statistical Computing, Vienna, Austria), the collected data of total hip arthroplasty patients were randomly divided into a modeling group (70%) and a validation group (30%) by simple random sampling without stratification to ensure scientific and unbiased data allocation. Subsequently, univariate analysis was performed on the modeling group data using SPSS 26.0 software (IBM Corp., Armonk). Categorical variables were assessed by chi-square test after confirming that the test assumptions, including expected frequency ≥ 5 in each cell, were met. If these assumptions were violated, Fisher’s exact test was used instead. Before conducting multivariate logistic regression, multicollinearity among these candidate variables was evaluated by calculating variance inflation factors. Variables with VIF > 5 were considered to exhibit significant collinearity and were managed accordingly to ensure model stability. From this analysis, all variables with a P-value of <.05 were screened out, which showed statistically significant variability, suggesting a potential association with postoperative constipation. Further, we included these screened variables in a multifactor logistic regression analysis to more rigorously assess their independent predictive value. Through this analysis, we identified variables with a P-value of <.05 as independent risk factors for postoperative constipation after total hip arthroplasty, thus providing strong data to support clinical decision-making. In order to translate this finding into a practical tool in clinical practice, we used R software to draw a nomogram, an intuitive chart that can help clinicians quickly assess a patient’s risk of postoperative constipation, based on the identified independent risk factors. Finally, we plotted receiver operating characteristic curves not only in the modeling group but also in the independent validation group and calculated the area under the curve to quantify the discriminatory ability of the model. In addition, by plotting correction curves and decision curves, we further evaluated the predictive accuracy and clinical applicability of the model to ensure its reliability and value in practical applications.

All collected clinical variables were included in the initial univariate logistic regression analysis to comprehensively assess potential associations with postoperative constipation. A total of 16 variables were evaluated, including age, sex, body mass index, smoking status, alcohol consumption, educational level, marital status, living situation, dietary pattern, anxiety, disease type, history of constipation, bedridden time, operative time, intraoperative blood loss, and catheter removal time. These variables are summarized in Table 1.

Table 1.

Unifactorial analysis of constipation after total hip arthroplasty.

Risk factors	Constipation group (N = 220)	Normal group (N = 85)	P
Sex			.691
Male	89	40
Female	111	45
Age (yr)			.004
≤70	83	51
>70	117	34
BMI (kg/m2)			.223
≤24	126	47
>24	74	38
Smoking			.398
Yes	74	27
No	126	58
Drinking			.021
Yes	88	25
No	112	60
Educational level			.063
Junior high school and below	154	50
High school and above	66	35
Disease type			.024
Arthritis	77	45
Fracture	123	40
Spouse			.317
Yes	121	46
No	79	39
Regularity of life			.166
Yes	124	60
No	76	25
Regular diet			.012
Yes	122	65
No	78	20
Anxiety			.015
Yes	55	12
No	145	73
Bed ridden time (h)			.011
≤48	131	42
>48	69	43
Preoperative constipation			.001
Yes	157	51
No	43	34
Surgical time (min)			.186
≤90	125	46
>90	75	39
Intraoperative bleeding (mL)			.833
≤200	132	55
>200	68	30
Removal time of urinary catheter (h)			.023
≤24	86	49
>24	114	36

BMI = body mass index.

3. Results

3.1. General situation

This study included 436 patients who underwent total hip arthroplasty. Among them, 314 patients developed constipation after the procedure, with an incidence rate of 72.02%. To ensure proper group allocation, all 436 patients were randomly assigned to either the modeling group (n = 305) or the validation group (n = 131) in a strict 7:3 ratio using simple random sampling. This study included 16 potential predictor variables for constructing a multivariate logistic regression model. According to the commonly accepted rule of thumb in logistic regression modeling, at least 10 to 15 outcome events are required per predictor to ensure model stability and prevent overfitting. Therefore, a minimum of approximately 240 events was needed. In our cohort of 436 patients, 314 experienced postoperative constipation, exceeding the required threshold and providing adequate statistical power for reliable model development.

3.2. Independent risk factors for constipation after total hip arthroplasty

In the modeling group, 16 variables were analyzed by univariate logistic regression analysis, and the results showed that 8 variables were potential risk factors for constipation after total hip arthroplasty, including age, alcohol consumption, type of disease, dietary habits, anxiety disorders, bedtime, history of constipation, and time of urinary catheter removal (Table 1). Multifactorial logistic regression analysis was performed to determine age > 70 years (odds ratio [OR], 3.651; 95% confidence interval [CI], 1.678–5.843), irregular diet (OR, 3.074; 95% CI, 1.539–4.125), anxiety (OR, 3.123; 95% CI, 1.573–4.368), bedridden for >48 hours (OR, 5.244; 95% CI, 1.625–6.376), and history of constipation (OR, 6.190; 95% CI, 1.872–7.855) were the independent risk factors for constipation after total hip arthroplasty (Table 2).

Table 2.

Multifactorial analysis of constipation after total hip arthroplasty.

Factors	β	SE	Wald χ2	P	OR	95% CI
Age > 70 yr	1.295	0.347	13.928	.006	3.651	1.678–5.843
Irregular diet	1.123	0.358	9.84	.009	3.074	1.539–4.125
Anxiety	1.139	0.354	10.352	.008	3.123	1.573–4.368
Bedridden for >48 h	1.657	0.374	19.629	<.001	5.244	1.625–6.376
History of constipation	1.823	0.362	25.36	<.001	6.190	1.872–7.855

CI = confidence interval, OR = odds ratio, SE = standard error.

3.3. Nomogram development and validation

Based on the screened independent risk factors, we constructed a nomogram (Fig. 1), which was designed to accurately predict the risk of constipation in patients after total hip arthroplasty. The discriminative performance of the model was assessed using receiver operating characteristic curves. The area under the curve was 0.827 for the modeling group and 0.821 for the validation group (Fig. 2A, B), indicating good discriminatory ability. Clinically, this suggests that the model has over 80% probability of correctly distinguishing between a patient who will and will not develop postoperative constipation, supporting its potential utility in preoperative risk assessment. Further, we demonstrated the calibration curves (Fig. 2C, D), which showed that the risk of constipation predicted by the nomogram was highly consistent with the actual observed risk, ensuring the reliability of the model in terms of predictive accuracy. Meanwhile, the results of the decision curve analysis (Fig. 2E, F) support the practical value of nomogram in clinical decision-making, showing that it can help doctors and patients make better medical decisions.

Figure 1.

Nomogram prediction model for constipation after total hip arthroplasty.

Figure 2.

Receiver operating characteristic curves for nomograms predicting postoperative constipation after total hip arthroplasty in training set (A) and validation set (B). Nomogram calibration curves for predicting constipation after total hip replacement in training set (C) and validation set (D). Decision curves for the nomogram used to predict constipation after total hip replacement in training set (E) and validation set (F).

4. Discussion

Constipation, manifested by decreased frequency of defecation, difficulty in defecation, feeling of incomplete defecation or discharge of dry and hard feces with anorectal obstruction sensation, is a common gastrointestinal problem in patients with joint replacement.^[11] Despite the absence of obvious organic pathology, its negative impact on the nutritional status of patients should not be underestimated, and may lead to prolonged hospitalization and increased healthcare costs, as well as a significant reduction in postoperative quality of life, posing an obstacle to the recovery process and increasing the complexity of care. The predictors focused on in this study are prevalent and easily identifiable in the clinic, and a nomogram prediction model was constructed based on the 5 major independent risk factors identified. After rigorous validation, the model demonstrated good predictive performance, providing a powerful tool for early identification and intervention of constipation risk in clinical practice, which is expected to optimize patients’ postoperative rehabilitation processes and care strategies and reduce the healthcare burden. Through the application of this model, healthcare professionals are able to more accurately assess the risk of postoperative constipation in patients and take timely interventions, thereby promoting the overall recovery and quality of life of patients.

In this study, we revealed that patients older than 70 years of age are significant risk factors for elevated risk of constipation after total hip arthroplasty. It has been found that elderly patients generally have reduced digestive system function and weakened intestinal peristalsis, which explains to some extent why age > 70 years can be a risk factor for postoperative constipation.^[12] With age, the density and mobility of intestinal smooth muscle cells decrease, coupled with decreased elasticity of intestinal blood vessels and reduced blood supply, which together result in decreased peristalsis and absorption function of the intestines, thus increasing the risk of constipation.^[13] In addition, some chronic diseases common in the elderly population, such as diabetes mellitus and Parkinson’s disease, as well as the long-term use of certain medications (e.g., analgesics, antidepressants) also indirectly affect intestinal function, further exacerbating constipation conditions.^[14] The superimposed effect of these factors and surgical trauma may have jointly contributed to the occurrence of constipation after total hip arthroplasty. The results of the present study are consistent with previous reports in the literature, which showed that the risk of postoperative constipation increased 1.2-fold for every 10-year increase in age.^[15] However, the significance of the risk of constipation we observed in patients aged > 70 years suggests that this particular age group may require more careful clinical attention and management.

In this study, irregular diet was found to be a risk factor for constipation after total hip arthroplasty. It was found that the effects of irregular diet on intestinal health are mainly reflected in the following aspects: firstly, it destroys the balance of intestinal flora, reduces the types and number of beneficial bacteria, and leads to a decrease in intestinal barrier function; secondly, it affects the secretion of digestive enzymes and the regularity of intestinal peristalsis, thus slowing down the propulsion of food residue in the intestinal tract, increasing the time that feces stays in the colon, and causing water to be over-absorbed, which makes the feces dry and hard and difficult to expel.^[16] These mechanisms work together to increase the risk of constipation. Previous studies have also confirmed the association between irregular diet and constipation. For example, prospective studies have shown that the risk of constipation is approximately 60% higher in adult participants who eat an irregular diet compared to those who eat a regular diet.^[17] In addition, a large cross-sectional survey found that the incidence of constipation was 1.8 times higher in individuals with irregular eating habits than in those with regular diets.^[18] Although these studies have focused primarily on the general population, they provide an important reference for understanding the relationship between irregular eating and constipation.

In this study, anxiety was found to be a risk factor for constipation after total hip arthroplasty. The association between anxiety and constipation was found to be explained by several mechanisms. First, anxiety activates the sympathetic nervous system, leading to a decrease in intestinal smooth muscle contraction, which in turn slows down intestinal peristalsis and increases the time that feces remain in the intestines, ultimately promoting constipation. Secondly, anxiety affects the microecological balance of the intestinal tract and reduces the beneficial intestinal flora, further interfering with normal digestion and defecation. In addition, anxiety may lead to changes in patients’ diet and sleep patterns, indirectly affecting intestinal health.^[19] Our findings echo previous studies but provide a more specific analysis of postoperative scenarios. One study found that the prevalence of constipation was 3 times higher in patients with anxiety disorders than in the general population^[20]; and another study animal experiments revealed how anxiety affects gut microecology through the gut-brain axis, thereby promoting digestive disorders.^[21] These studies provide strong evidence for the association between anxiety and constipation, but the present study confirms this association for the first time in the specific context of postoperative total hip replacement, emphasizing the non-negligible role of anxiety in postoperative rehabilitation.

In this study, bedridden for >48 hours was found to be a risk factor for constipation after total hip arthroplasty. It has been found that prolonged bedriddenness leads to a slowing of intestinal peristalsis, which is one of the key mechanisms in the development of postoperative constipation.^[22] Lack of physical activity reduces the contraction of intestinal smooth muscle and decreases intestinal propulsive force, which increases the retention time of feces in the large intestine, making water over-absorption and feces hard and difficult to pass.^[23] In addition, the bedridden state may also affect the normal secretion of digestive enzymes and the balance of intestinal flora, further interfering with the digestion and defecation process.^[24] The results of the present study are consistent with previous studies, but provide a more refined point-in-time analysis. It was noted that the risk of constipation increased by approximately 20% for each additional 24 hours of postoperative bed rest.^[25] Together, these studies support a positive association between bed rest time and constipation risk.

In this study, history of constipation was found to be a risk factor for constipation after total hip arthroplasty. It was found that chronic constipation leads to reduced intestinal muscle tone, impaired peristalsis, and imbalances in the intestinal microenvironment (including abnormal intestinal flora), which are further amplified by postoperative stress and increase the risk of constipation.^[26] In addition, a history of constipation may be associated with abnormalities of the enteric nervous system, which affects the intestinal perception and propulsion of food debris, thus making constipation more likely after surgery.^[27] This long-term intestinal dysfunction is more likely to trigger or exacerbate constipation symptoms in the context of surgical stress and activity restriction. The results of the present study are consistent with previous studies, but emphasize the unique role of a history of previous constipation in postoperative constipation after total hip arthroplasty. Studies have shown that patients with a history of constipation have a 2.5 times greater risk of postoperative constipation than patients without a history of constipation.^[28] Together, these studies emphasize the significant impact of a previous history of constipation on the risk of constipation during postoperative recovery.

Although this study identified several statistically significant risk factors for postoperative constipation following total hip arthroplasty, it is important to emphasize that the findings suggest associations rather than causality. Due to the retrospective and observational nature of the study, causal inferences cannot be definitively established. These associations should be interpreted with caution, and further prospective studies or randomized controlled trials are warranted to validate the causal relationships between these variables and the occurrence of postoperative constipation.

Based on the identified independent risk factors, we developed targeted nursing interventions tailored to patients undergoing hip replacement surgery, with particular attention to those with a history of chronic constipation. Firstly, nutritional management plays a crucial role. Patients are advised to increase dietary fiber intake before and after surgery by consuming more fresh fruits, vegetables, and whole grains. Maintaining a light, easily digestible diet and ensuring adequate hydration are emphasized. Postoperatively, small frequent meals are encouraged while avoiding spicy or irritating foods. Additionally, consumption of foods with natural laxative properties, such as honey, sesame oil, and bananas, is recommended. Secondly, early mobilization and physical activity are strongly promoted to enhance intestinal motility. Patients are guided to perform deep breathing exercises, abdominal muscle contractions, and limb function exercises as tolerated. Nursing staff also apply complementary techniques such as clockwise abdominal massage, stimulation of acupuncture points related to bowel function (e.g., large intestine shu point, tian shu point), and gentle tapping of the lumbar and sacral regions to facilitate peristalsis. Thirdly, establishing regular bowel habits is facilitated by creating a calm, clean, and private environment for defecation, including the use of screens or curtains to protect patient privacy and reduce psychological barriers. For patients with severe constipation, pharmacological interventions such as lactulose, magnesium oxide, or glycerin enemas may be employed under medical supervision. However, emphasis is placed on prioritizing non-pharmacological interventions and closely monitoring potential side effects to avoid overreliance on laxatives. Furthermore, multidisciplinary collaboration is advocated. Dietitians contribute to individualized nutritional plans, while rehabilitation therapists assist with tailored exercise regimens to optimize postoperative recovery and bowel function. Health education is also strengthened to empower patients and their families with knowledge on constipation prevention, the risks of laxative overuse, proper toileting techniques, and the importance of developing regular eating and defecation habits. Patients are encouraged to promptly report any urge to defecate to healthcare providers, ensuring timely management.

Compared to previous studies that primarily focused on the prevalence or descriptive factors of postoperative constipation, our study goes a step further by constructing and validating a predictive nomogram model. Notably, while Yue et al^[4] conducted a randomized trial focusing on prevention strategies, and Lin et al^[6] explored constipation complications, few studies have integrated multiple psychosocial and perioperative variables into a prediction framework. Our model incorporates easily obtainable clinical indicators and achieves good discrimination (AUC > 0.82), enhancing its clinical applicability. These findings suggest our model may serve as a valuable addition to current literature by bridging the gap between epidemiological observation and practical risk assessment.

From a clinical perspective, the nomogram developed in this study offers a practical, visual tool to assist physicians and nursing staff in stratifying patients according to their risk of postoperative constipation. By identifying high-risk individuals preoperatively or in the early postoperative period, targeted interventions – such as dietary fiber supplementation, early mobilization, psychological support, and prophylactic laxatives – can be implemented. The model can also be integrated into electronic medical record systems to automate risk alerts and support clinical decision-making, thus promoting individualized and timely care. Its simplicity and accessibility enhance its potential for adoption in routine orthopedic nursing workflows.

This study has several limitations. First, its retrospective design may introduce selection and information biases, particularly in subjective variables such as dietary patterns and anxiety, which were derived from physician and nursing documentation rather than standardized assessment tools. These biases may affect the accuracy and consistency of data interpretation. Second, since the data were collected from a single medical center, the study population may not be representative of broader or more diverse populations, thereby limiting the generalizability of the results. Third, although several important variables were included, some potential confounding factors – such as baseline gastrointestinal function, preoperative bowel habits, perioperative opioid dosage, and psychological interventions – were not captured due to documentation limitations, which may have influenced the observed associations. Fourth, while statistical methods were employed to control for confounding, unmeasured and residual confounders cannot be fully excluded. In addition, some of the study results exhibited a degree of heterogeneity, which may reflect differences in patient demographics, perioperative care protocols, or data recording practices. This heterogeneity could impact the precision and reproducibility of the model. Moreover, given the model was developed and validated using the same institutional dataset, the potential for overfitting exists despite internal validation. Therefore, external validation using independent, multicenter datasets is warranted to enhance the model’s robustness and clinical utility. Future research should aim to conduct prospective, multicenter studies with larger and more diverse populations, incorporate standardized assessments for psychosocial variables, and evaluate the integration of this nomogram into clinical workflows. Such efforts will help validate, optimize, and operationalize the model in real-world orthopedic care settings.

5. Conclusion

Postoperative hip replacement patients have a high incidence of constipation due to the combined effects of multiple factors. Constipation not only adversely affects patients’ physiological functions but also increases their psychological burden, thereby impairing postoperative rehabilitation outcomes.Therefore, healthcare professionals should actively implement comprehensive intervention measures to prevent and alleviate constipation, including dietary guidance, psychological support, massage and exercise interventions, preoperative education and training, health education, and pharmacological treatment when necessary. Through multidimensional interventions, it is possible to effectively alleviate patients’ discomfort, improve postoperative quality of life, and promote the rehabilitation process.

Acknowledgment

I would like to thank Deng Guanghua for his guidance in analyzing the data and submitting my thesis.

Author contributions

Conceptualization: Lei Zou.

Data curation: Xun-da Zheng.

Formal analysis: Xun-da Zheng.

Investigation: Xun-da Zheng.

Methodology: Cheng-gui Wang.

Software: Cheng-gui Wang.

Validation: Tao Ma.

Visualization: Tao Ma.

Writing – original draft: Lei Zou.

Writing – review & editing: Lei Zou.