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      Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

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          Abstract

          In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023; 14: 784-790. It is well known that patients who have undergone a liver transplant (LT) may need to have a total hip arthroplasty (THA) or total knee arthroplasty (TKA) implanted. Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population. However, there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population (individuals without LT). Therefore, in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population. Therefore, future research should attempt to resolve this controversy.

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          Clinical Outcomes following Primary Hip Replacement Arthroplasties in Patients with Solid Organ Transplantation: A Systematic Review and Meta-Analysis

          Chul-Ho Kim, Eic Lim, Jeuk Lee (2022)
          There is still controversy regarding clinical outcomes following primary hip arthroplasty after solid organ transplantation (SOT). The aim of this study was to determine whether clinical outcomes after hip arthroplasty differ between previous SOT recipients and control subjects with no history of undergoing SOT. We conducted a systematic search of MEDLINE, Embase, and the Cochrane Library for studies comparing the clinical outcomes after hip arthroplasty following SOT published up to January 5, 2022. A comparison of medical and surgery-related complications, as well as the readmission rate and 90-day mortality rate between previous SOT recipients and control subjects was performed. Subgroup analyses of the SOT types, liver transplantation (LT) and kidney transplantation (KT), were also performed. Ten studies that included 3,631,861 cases of primary hip arthroplasty were included; among these, 14,996 patients had previously undergone SOT and 3,616,865 patients had not. Significantly higher incidences of cardiac complications, pneumonia, and acute kidney injury were observed in the SOT group compared with the control group. Regarding surgical complications, a higher transfusion rate was observed in the SOT group. The readmission rate and 90-day mortality rate were also significantly higher in the SOT group. A significantly higher incidence of deep vein thrombosis was observed in the KT subgroup compared with the control group. A higher risk of medical and surgical complications, as well as higher readmission and mortality rates after hip arthroplasty was observed for previous SOT recipients compared to patients with no history of SOT.
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            Safety and outcomes of hip and knee replacement surgery in liver transplant recipients

            Mohamed Ahmed, Abdelrhman Abumoawad, Fouad Jaber … (2023)
            BACKGROUND Liver transplant (LT) is becoming increasingly common with improved life expectancy. Joint replacement is usually a safe procedure; however, its safety in LT recipients remains understudied. AIM To evaluate the mortality, outcome, and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery. METHODS Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database. RESULTS A total of 5046119 hip and knee replacement surgeries were identified. 3219 patients had prior LT. Mean age of patients with no history of LT was 67.51 [95% confidence interval (CI): 67.44-67.58], while it was 64.05 (95%CI: 63.55-64.54) in patients with LT. Patients with history of LT were more likely to have prolonged length of hospital stay (17.1% vs 8.4%, P < 0.001). The mortality rate for patients with no history of LT was 0.22%, while it was 0.24% for patients with LT (P = 0.792). Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization: 11.4% as compared to 6.2% in patients without history of LT (P < 0.001). The mortality rate between both groups during readmission was not statistically different (1.9% vs 2%, P = 0.871) respectively. CONCLUSION Hip and knee replacements in patients with history of LT are not associated with increased mortality; increased re-admissions were more frequent in this cohort of patients. Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.
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              Total joint arthroplasty following solid organ transplants: complications and mid-term outcomes.

              Christine J Wu, Adam C Brekke, Zoe W Hinton … (2022)
              Survival after solid organ transplant (SOT) is improving, and demand for total joint arthroplasty (TJA) among SOT recipients is rising. Outcomes including revision, periprosthetic joint infection, and survivorship based on SOT type are variable. We sought to compare peri-operative complications, implant survivorship, and mortality for patients undergoing TJA following SOT.
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                Author and article information

                Contributors
                E Carlos Rodriguez-Merchan
                Journal
                Journal ID (nlm-ta): World J Orthop
                Journal ID (publisher-id): WJO
                Title: World Journal of Orthopedics
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2218-5836
                Publication date Collection: 18 April 2024
                Publication date (Electronic): 18 April 2024
                Volume: 15
                Issue: 4
                Pages: 310-311
                Affiliations
                Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid 28046, Spain. ecrmerchan@ 123456hotmail.com
                Author notes

                Author contributions: There is only one author.

                Corresponding author: E Carlos Rodriguez-Merchan, PhD, Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, Madrid 28046, Spain. ecrmerchan@ 123456hotmail.com

                Article
                Other ID: jWJO.v15.i4.pg310 Publisher-manuscript ID: 89229
                DOI: 10.5312/wjo.v15.i4.310
                PMC ID: 11045464
                SO-VID: 0a29f0de-3fe8-48f2-b5f2-d9d2f3088e86
                Copyright © ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 24 October 2023
                Date revision received : 22 January 2024
                Date accepted : 5 March 2024
                Categories
                Subject: Editorial

                Keywords: liver transplant,total knee arthroplasty,total hip arthroplasty,results,mortality
                Data availability:
                Keywords: liver transplant, total knee arthroplasty, total hip arthroplasty, results, mortality

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