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Total joint arthroplasty following solid organ transplants: complications and mid-term outcomes

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Abstract

Purpose

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.

Methods

A retrospective review of the institutional database for primary TJA among SOT recipients from 2000 to 2020 was performed. Revisions, conversion TJA, and patients with multiple organ transplants were excluded. Patients were stratified by transplant organ. Transfusions, 90-day readmissions and emergency department (ED) visits, revisions, and mortality were compared using descriptive statistics and Cox proportional hazard ratios.

Results

A total of 119 total hip arthroplasties (THA) and 63 total knee arthroplasties (TKA) in SOT recipients were studied. Most common SOT was renal (39%), then lung (27%), liver (24%), and heart (10%). TKA postoperative transfusion rates varied by organ (p = 0.037; [heart 0%, liver 9.5%, renal 24.0%, lung 50.0%]). Implant survivorship was 95.6% at one year (95% CI 90.3–98.1) and 92.1% at four years (83.9–96.3). Mortality was 2.9% at one year (95% CI 1.1–7.4) and 23.2% at four years (95% CI 16.1–32.3). After adjusting for procedure, duration from transplant to TJA, age, and Elixhauser Index, lung recipients had higher mortality versus heart (RR 4.39 [95% CI 1.64–15.38]; p = 0.002), kidney (7.98 [3.04–24.61]; p < 0.001), and liver (7.98 [3.04–24.61; p < 0.001) patients.

Conclusion

TJA after SOT yields acceptable peri-operative outcomes and implant survivorship, but mortality risk is substantial, especially among lung transplant recipients.

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Fig. 1

Source: The Annual Data Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients (2018)

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University, DUMC Box 104002, Durham, NC, 27710, USA

    Christine J. Wu, Zoe W. Hinton, Sean P. Ryan, Michael P. Bolognesi & Thorsten M. Seyler

  2. Texas Hip and Knee Center, 5450 Clearfork Main Street Ste 100, Fort Worth, TX, 76107, USA

    Adam C. Brekke

  3. School of Medicine, Duke University, DUMC 3710, Durham, NC, 27710, USA

    Billy I. Kim

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Contributions

All authors contributed to either data collection, analysis, or writing the manuscript.

Corresponding author

Correspondence to Christine J. Wu.

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This study has been approved by the Duke University Health System Institutional Review Board.

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All authors give their consent to publish if accepted by the Editorial Board.

Competing interests

Financial interests: author TMS: IP royalties from Pattern Health, Restor3d; publishing royalties, financial or material support from Lippincott Williams & Wilkins; paid consultant for Total Joint Orthopedics, Smith & Nephew, Heraeus Medical; research support from Zimmer Biomet, Next Science.

Author MPB: IP royalties from TJO and Zimmer; stock or stock options Amedia, TJO; research support from Zimmer, Biomet, DePuy, A Johnson & Johnson, Exactech, Inc., KCI; other financial or material support from Acelity, AOA Omega, Smith & Nephew.

Non-financial interests: author TMS: board or committee member, American Association of Hip and Knee Surgeons; board or committee member, Musculoskeletal Infection Society.

Author MPB: board or committee member, American Association of Hip and Knee Surgeons; editorial or governing board Arthroplasty Today; board or committee member, Eastern Orthopaedic Association; editorial or governing board, Journal of Arthroplasty.

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Wu, C.J., Brekke, A.C., Hinton, Z.W. et al. Total joint arthroplasty following solid organ transplants: complications and mid-term outcomes. International Orthopaedics (SICOT) 46, 2735–2745 (2022). https://doi.org/10.1007/s00264-022-05597-6

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