The safety and outcome of joint replacement surgery in liver transplant recipients

Abstract

A small group of patients may require total hip arthroplasty, total knee arthroplasty, or other joint replacement surgery after OLT for osteoporotic fractures, osteonecrosis, and osteoarthritis. Although arthroplasty is safe in the general population, its safety in liver transplant recipients is unclear. The aim of the study was to determine the safety and outcome of joint replacement surgery in our liver transplant recipients. A retrospective analysis was performed on all liver transplant recipients who had total joint arthroplasty at a single teaching institution between 1986 and 2002. Data regarding major intraoperative and postoperative complications was obtained from the medical charts and a hospitalbased computer system. Of over 1,200 liver transplant recipients, we identified 7 patients who underwent 12 total arthroplasties (8 knee, 3 hip, 1 ankle). Joint replacements were performed electively for osteonecrosis (5 of 12) and osteoarthritis (5 of 12), whereas two hip arthroplasties were performed emergently for fractures. All patients with osteonecrosis or hip fracture had been treated with prolonged corticosteroids. There were no deaths or major complications in the intraoperative and postoperative periods. On long-term follow-up, no patients have had pain, dislocation, or infection in the postsurgical joint. No joint revision surgery has been required. In conclusion, a small number of stable liver transplant recipients at our institution underwent joint replacement surgery without major short-term or longterm complications. Our study suggests that joint replacement surgery may be safely and successfully performed in this population, although larger, randomized, prospective trials are needed to confirm our findings. (Liver Transpl 2003;9:373-376.)

The Impact of Solid Organ Transplant History on Inpatient Complications, Mortality, Length of Stay, and Cost for Primary Total Hip Arthroplasty Admissions in the United States

“…Our results also suggest that there are differences in blood loss and LOS in transplant recipients compared to non-transplant patients. Unlike our results, Levitsky et al [38] reported that in the 12 patients in their study who underwent liver transplantation and THA, the average blood loss was 185 CC (range, 100 to 250) and average LOS was 7 days (range, 3 to 14), which was comparable to THA performed in healthy immunocompetent individuals.…”

Early Postoperative Outcomes of Primary Total Knee Arthroplasty After Solid Organ Transplantation in the United States, 1998–2011

“…Some of the smaller case series have reported mean LOS as low as 3.6 days 12 (based on n=5) and as high as 7.3 days (±3.5) 13 (based on n=5).…”

“…The limited reports in the literature are dominated by small case series, which focus on the safety of the procedure and generally conclude that TKA following liver 13 , heart 14 , lung 12 , or kidney 15 transplant is a safe procedure with few complications and successful outcomes. Levitsky et al 13 reported on major intraoperative and postoperative complications for 8 TKA procedures in 5 patients with a history of liver transplantation.…”

“…Levitsky et al 13 reported on major intraoperative and postoperative complications for 8 TKA procedures in 5 patients with a history of liver transplantation. These patients suffered no major or minor complications other than one patient requiring a blood transfusion.…”

Total Joint Arthroplasty in Transplant Recipients: In-Hospital Adverse Outcomes

“…However, these infectious complications can be prevented by optimizing care of these patients prior to surgery. Studies in the TJA literature have demonstrated that these patients may not have a greater risk for infection than the general population [21][22][23]. However, the aforementioned studies may have been unable to capture the relationship between transplant and infections due to power issues as they had small sample sizes involving no greater than 20 patients and 33 TJA surgeries.…”