Hip arthroplasty in patients with cirrhosis of the liver

Hsieh, Pao-Shiu; Chen, L.-H.; Lee, M.-S.; Chen, C.-H.; Yang, Wen-E; Shih, Chun–Hsiung

doi:10.1302/0301-620x.85b6.14278

Cited by 47 publications

(40 citation statements)

References 25 publications

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“…14 The only previously study that exclusively evaluated the safety of hip arthroplasty is a recent uncontrolled study from Taiwan that overall perioperative complication rate was 26.7%. 17 The previously published data on the outcome of TKA in cirrhotic patients were included 41 Child's A cirrhotic patients and only 1 Child's B patient from a recent study in Taiwan. 11 They reported an overall perioperative complication rate was 43.1%.…”

Section: Discussionmentioning

confidence: 99%

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

Seol

Yoon

Lee

et al. 2017

Journal of Orthopaedics

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Objective: Present helpful measures to prevent expected complications that occur in patients with liver cirrhosis undergoing arthroplasty. Methods: 218 patients who underwent hip or knee arthroplasty were included in this study. Prognoses of patients with underlying disease of liver cirrhosis and those without are compared with measures. Results: Patients with liver cirrhosis show an increase in amount of bleeding, hospital stay and infection rate compared to those who do not. Conclusion: The risk of arthroplasty on patients with liver cirrhosis is higher than normal patients. Surgeons should carefully assess all cirrhotic patients pre-and postoperatively.

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Section: Discussionmentioning

confidence: 99%

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

Seol

Yoon

Lee

et al. 2017

Journal of Orthopaedics

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“…In all three cirrhosis subtypes, the largest effect size was seen for thrombocytopenia. This may be due to the fact that thrombocytopenia is associated with chronic liver disease[29]; furthermore, thrombocytopenia increases the risk for complications following TJA[13,15,25]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Cirrhosis on Resource Use and Inpatient Complications in Patients Undergoing Total Knee and Hip Arthroplasty

Newman

Schiltz

Mudd

et al. 2016

The Journal of Arthroplasty

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Background Cirrhosis is a major cause of morbidity and mortality and is an important risk factor for complications in surgical patients. The purpose of this study was to investigate the association of cirrhosis with postoperative complications, length of stay (LOS), and costs among patients who underwent total knee (TKA) or hip (THA) arthroplasty. Methods Using the Nationwide Inpatient Sample between 2000 and 2011, we identified patients who had a primary TKA or primary THA. TKA patients were divided into two groups: 1) cirrhosis (n= 41,464) and 2) no cirrhosis (n= 5,721,297) and THA patients were divided into two groups: 1) cirrhosis (n= 27,401) and 2) no cirrhosis (n= 2,622,539). Patient demographics, comorbidities, perioperative complications, LOS, incremental costs were analyzed. An additional subgroup analysis by cirrhosis etiology was performed. Results Multivariable analysis revealed cirrhosis was associated with 1.55 (95%CI: 1.47–1.63) times higher odds of any complication after TKA, and 1.59 (1.50–1.69) higher odds after THA. Adjusted outcomes showed cirrhotic TKA patients had $1,857 higher costs and 0.30 days longer LOS, and THA cirrhotic patients had $1,497 higher costs and 0.48 longer LOS. We found similar results for each cirrhosis subtype, but alcohol-related had the highest resource use and complication rate. Conclusion Patients with cirrhosis who are undergoing TKA or THA are at a significantly increased risk for perioperative complications, increased LOS and higher costs. The perioperative complications and costs were highest among patients with alcohol-related cirrhosis.

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“…However, data are extremely limited on the safety and outcome of hip or knee arthroplasty in patients with advanced liver disease (12, 13, 19). Ziser et al (8) evaluated 733 patients with a diagnosis of liver cirrhosis who had undergone some type of surgical procedure, and reported a perioperative complication rate of 30.1% and a mortality rate of 11.6% within 30 days of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Only two recent studies (12, 13), to the best of our knowledge, have evaluated the perioperative risks of hip arthroplasty in cirrhotic patients. The purpose of this study was to document perioperative morbidity and mortality in patients with liver cirrhosis undergoing hip arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Risk of Hip Arthroplasty in Patients with Cirrhotic Liver Disease

et al. 2007

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We retrospectively reviewed the complete medical records of 30 patients with a diagnosis of liver cirrhosis who had undergone hip arthroplasty at three academic institutions between October 1994 and May 2001. There were 26 males and 4 females with a mean age of 60 yr at index operation. Surgical procedures included 17 primary total hip arthroplasties (THA), 8 bipolar hemiarthroplasties, and 5 revision THAs. According to the Child-Pugh scoring system, 19 cirrhotic patients were categorized as class A, 9 as class B, and 2 as class C. Eight (26.7%) of the 30 patients had one or more perioperative complications. Of these, wound infection was the most common, with a rate of 10% (3 of 30 hips). Other perioperative complications included surgical site bleeding, coagulopathy, encephalopathy, gastrointestinal bleeding, pneumonia, and arrhythmia. Death occurred in 2 (6.7%) of the 30 patients; both were Child-Pugh's C cirrhotics. A higher Child-Pugh score (p=0.0001) and a high level of creatinine (p=0.0499) were associated with significantly increased perioperative complications or death. Our findings suggest that surgeons should be vigilant about perioperative complications in patients with advanced cirrhotic liver disease who undergo hip arthroplasty, albeit the mortality rates are relatively low in less severe cirrhotics.

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Hip arthroplasty in patients with cirrhosis of the liver

Cited by 47 publications

References 25 publications

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

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

Impact of Cirrhosis on Resource Use and Inpatient Complications in Patients Undergoing Total Knee and Hip Arthroplasty

Perioperative Risk of Hip Arthroplasty in Patients with Cirrhotic Liver Disease

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