Abstract
Background
Joint replacement surgery has been shown to be successful in post solid organ transplantation patients. However, complication rates, revision rates, and overall mortality can be higher in this population compared to patients who have not undergone solid organ transplantation. Many transplant patients have a decreased life expectancy. Therefore, literature suggests that joint replacement surgery be offered to qualifying patients early on when symptomatic. This study compares the outcomes of patients who have undergone solid organ transplantation as well as a joint replacement to patients that have only undergone joint replacement surgery.
Methods
We retrospectively gathered 42 transplant (T) patients over a ten year period, 2003–2013, that underwent a liver (21) or kidney (21) transplant as well as primary total knee arthroplasty (TKA) (23) or total hip arthroplasty (THA) (19). We then gathered 42 non-transplant (NT) patients matched for procedure, age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, and age adjusted Charlson co-morbidity index (ACCI) score who only underwent TKA or THA with no transplant. We used Chi-Square, T test, and multivariate analysis to compare the two groups with regard to number of complications (NOC), readmissions at 30 and 90 days post surgery, length of stay (LOS), number of intensive care unit (ICU) admissions, and total direct cost (TDC) per hospital stay.
Results
We found no significant difference between the two groups with regard to LOS (P=0.267), readmissions at 30 days (P=0.843) or 90 days (P=0.265), ICU admissions (P=0.326), or TDC per hospital stay (P=0.343). The T group had significantly higher NOC compared to the NT group (P=0.022). The type of transplant was associated with a higher NOC with kidney transplant patients having 6.75 (95% CI 1.318–34.565) times higher odds of complications compared to liver transplant patients (P=0.022). The average time between transplant surgery and joint replacement surgery was 2.9 years.
Conclusion
Solid organ transplant patients are considered to be at higher risk for opportunistic infections compared to the general population. Limited data is available regarding the time at which transplant patients are at the highest risk for infection, or if one type of transplant is more at risk for complications than another after THA or TKA. This study suggests that transplant patients undergoing joint replacement surgery at an average of 2.9 years post-transplant are at higher risk for complications than a matched cohort of patients undergoing joint replacement alone, with kidney transplant patients being more at risk to experience a complication than liver transplant patients. To our knowledge, this is the first study to acknowledge the higher risk associated specifically with kidney transplant patients.
