Cirrhosis patients have increased risk of complications after hip or knee arthroplasty

Abstract

Background and purposeThe risk of complications in cirrhosis patients after orthopedic surgery is unclear. We examined this risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA).Patients and methods Using Danish healthcare registries, we identified all Danish residents who underwent a THA or TKA for primary osteoarthritis in the period 1995–2011. We compared the risk of complications in patients with or without cirrhosis.Results The surgical technique was similar in the 363 cirrhosis patients and in 109,159 reference patients, but cirrhosis patients were more likely to have been under general anesthesia (34% vs. 23%), were younger (median age 66 vs. 69 years), had a predominance of males (54% vs. 41%), had more comorbidity, and had had more hospitalizations preoperatively. Their risk of intraoperative complications was similar to that for reference patients (2.5% vs. 2.0%), but they had greater risk of dying during hospitalization or within 30 days of discharge (1.4% vs. 0.4%; aOR = 3.9, 95% CI: 1.5–10); greater risk of postoperative transfer to an intensive care unit (0.6% vs. 0.06%; aOR = 5.8, CI: 1.3–25) or a medical department (4.4% vs. 2.5%; aOR = 1.7, CI: 0.99–2.9); greater risk of readmission within 30 days of discharge (15% vs. 8%; aOR = 1.8, CI: 1.3–2.4); and greater risk of deep prosthetic infection (3.1% vs. 1.4%) or revision (3.7% vs. 1.7%) within 1 year. The chance of having an uncomplicated procedure was 81.0% (CI: 76.6–85.0) for cirrhosis patients and 90.0% (CI: 89.6–90.0) for reference patients.Interpretation Cirrhosis patients had a higher risk of postoperative complications after THA or TKA for primary osteoarthritis than patients without cirrhosis. This may have implications for orthopedic surgeons’ postoperative management of cirrhosis patients, and preoperative assessment by a hepatologist may be indicated.

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

“…Another single-institution retrospective study of 230 patients demonstrated an increased rate of early postoperative complications following total joint replacement in patients with cirrhosis. Within 90-days of the index arthroplasty procedure, patients with a diagnosis of cirrhosis had a higher rate of transfusion [P < .001], gastrointestinal [24]. Interestingly, the analysis showed no difference in the rate of intra-operative complications between the cirrhotic group and the control group.…”

“…Interestingly, the analysis showed no difference in the rate of intra-operative complications between the cirrhotic group and the control group. The authors highlighted that 81% of patients with cirrhosis did not have any intra-or postoperative complications, as compared to 91% of the patients in the reference group [24].…”

Acute kidney injury following primary hip and knee arthroplasty surgery

“…A number of case-controlled [10][11][12][13][14][15][16] and observational cohort studies [17][18][19] have previously examined risk factors for AKI following arthroplasty surgery. These include older age, 17 male sex, 18 higher body mass index, [10][11][12]19 increased weight, 13 preoperative renal impairment, 10,17 chronic obstructive pulmonary disease, 10 A variety of treatment related factors have been identified as being associated with AKI.…”

Outcome analysis of hip or knee arthroplasty in patients with cirrhotic liver disease

“…7 Cirrhosis of the liver, irreversible fibrosis of liver tissue leading to hepatic dysfunction, is a known risk factor for complications after THA and TKA. 8,9 However, studies of patients with cirrhosis undergoing THAs and TKAs generally have numerous shortcomings, including lack of a control group, small sample sizes, contradictory results, and the use of the Child-Pugh classification as a measure of disease severity. The Child-Pugh system has limited clinical use for orthopaedic surgeons for preoperative risk assessment of THAs and TKAs because it involves a subjective assessment of ascites and encephalopathy, entities that are rarely assessed by many orthopaedic surgeons.…”