Complications of total joint arthroplasty in solid organ transplant patients versus a large control group

Abstract

Background: Solid organ transplant patients are theoretically at increased risk for complications after total joint replacement due to immunosuppressive medication regimens and multiple medical comorbidities. There are a number of studies that report on outcomes of total joint arthroplasty (TJA) following solid organ transplant, however, the results are heterogeneous. This study evaluated the outcomes of TJA in solid organ transplant patients as compared to non-organ transplant controls at one academic medical center. Methods: This study was a single institution retrospective review of a consecutive series of patients who underwent joint replacement following solid organ transplant as compared to a control cohort over a 10year period. Univariable and multivariable generalized linear mixed effects models were used to compare the odds of readmission, infection, mortality, and being discharged home between transplanted (cases) and non-transplanted (control) patients. Results: Transplant and non-transplant cohorts had similar BMI, although transplant patients were younger (61 versus 65 years) and had a higher incidence of Diabetes (55% vs. 16%). On multivariable analysis, there was no difference in the odds of re-admission or rate of infection, but there was an increased risk of death and admission to a rehab facility in the transplant cohort. Conclusion: Overall, this study demonstrates that solid organ transplant alone does not increase the risk of peri-operative complications in patients who underwent hip and knee replacement. However, it should be expected that these patients have a higher mortality rate and that many of them will need to be discharged to a post-acute care facility.

Revision Total Hip Arthroplasty in Solid Organ Transplant Patients: A Propensity Score-Matched Cohort Study for Aseptic and Infected Revisions

“…also found no difference in peri-operative complications comparing SOT patients and matched controls who underwent primary total joint arthroplasty. [ 21 ]…”

“…To our knowledge, this is the first report on rTHA in SOT patients which stratifies by all-cause aseptic indications and infection. Several authors have previously highlighted an increased mortality in septic vs aseptic revisions [ 21 , [33] , [34] , [35] ]. For both SOT and nontransplant patients, we found worse outcomes in patients undergoing revision for infection, including longer LOS, as well as higher rates of 90-day readmission and 90-day re-revision.…”

“…[10] In a single institution review, Brown et al also found no difference in peri-operative complications comparing SOT patients and matched controls who underwent primary total joint arthroplasty. [21] Prior studies on rTHA in SOT patients are limited. Labaran et al investigated outcomes after revision hip and knee arthroplasty in renal transplant patients using a large Medicare database from 2005 to 2015 [10].…”

30-Days to 10-Years Mortality Rates following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of the Last Decade (2011–2021)

“…40 Investigators also suggested increased adiposity provides greater metabolic reserves for catabolic illnesses such as heart failure. 40 Given that cardiovascular disease is one of the leading causes of death in TKA patients at all time points, these physiological mechanisms may partly explain the obesity paradox, if observed at all in TKA patients. 16,20,21 However, it should be noted that the obesity paradox is not a linear trend, and that unfavorable outcomes following joint replacement exist at either end of the BMI spectrum to reveal a "U"-shaped relationship 41 .…”

Revision arthroplasty in 2020

“…The impact of systemic diseases such as Diabetes and Chronic kidney disease and outcomes in patients with solid organ transplant is important to realize in view of a burgeoning population of these subgroups of patients. 7 Metal on Metal (MoM) articulations spelt doom for the patients and a large number out of over a million articulations implanted worldwide are still in situ. Chang and Haddad 8 outline, in their work, the understanding of the aetiology, presentation and management strategies for these patients with an aim to optimize their clinical outcomes.…”