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Increased Complication Rates After Hip and Knee Arthroplasty in Patients With Cirrhosis of the Liver

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Risk stratification is critical in patients with cirrhosis undergoing THAs and TKAs, as they may be more likely to have serious medical and surgical complications. As opposed to the Child-Pugh scoring system, which has limited use for orthopaedic surgeons inexperienced in assessing ascites and hepatic encephalopathy, the Model for End-stage Liver Disease (MELD) is an easily calculated, validated scoring system for severity of liver disease based on common laboratory values; however, its usefulness for predicting complications after elective arthroplasty has not been studied.

Questions/purposes

The purposes of this study were to determine the differences between patients with cirrhosis and control subjects in (1) hospital length of stay, discharge disposition, and readmission within 90 days; (2) early postoperative (90 days) medical complications potentially related to liver disease; (3) surgical complications within 90 days and any time after the procedure; (4) mortality rates after THA and TKA; and in addition, (5) to use the MELD score as a predictor for risk of complications and mortality.

Methods

Institutional database query software used coding data identified 115 patients with liver cirrhosis before having THAs or TKAs from 2000 to 2012 and 115 control subjects without cirrhosis matched by age, sex, procedure, and year of surgery. Early postoperative and longer-term medical and surgical complications were compared. Regression analysis was used to determine a MELD score that predicted greater risk of complications.

Results

Compared with matched control subjects, patients with cirrhosis had prolonged length of stay and higher rates of discharge to nursing facilities, readmission in 90 days, and urinary tract infections (p < 0.01), renal failure (p = 0.03), blood transfusions (p < 0.01), gastrointestinal hemorrhage (p = 0.04), dislocations (p = 0.01), infections (p = 0.02), and revisions (p = 0.04) within 90 days. One-year (p = 0.01) and longer-term (p = 0.0002) mortality rates were greater in patients with cirrhosis. A MELD score of 10 or greater predicted a three times increased likelihood (odds ratio [OR]) of any complication (95% CI, 1.28–7.00; p = 0.01) and 4.1 times increased likelihood (OR) of death (95% CI, 1.42–11.86; p < 0.01).

Conclusions

Patients with cirrhosis undergoing THAs and TKAs should be counseled regarding their increased risk of medical complications, surgical complications, and death. A MELD score of 10 or greater is associated with a high rate of complications, although this finding needs further validation because we were unable to control for all medical confounders.

Level of Evidence

Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    John V. Tiberi III MD & Hany Bedair MD

  2. Harvard Medical School, Boston, MA, USA

    John V. Tiberi III MD & Hany Bedair MD

  3. Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA

    Viktor Hansen MD

  4. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

    Naglaa El-Abbadi MS, MPH

  5. Kaplan Center for Joint Reconstruction Surgery, Newton, MA, USA

    Hany Bedair MD

Authors
  1. John V. Tiberi III MD
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  2. Viktor Hansen MD
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  3. Naglaa El-Abbadi MS, MPH
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  4. Hany Bedair MD
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Corresponding author

Correspondence to John V. Tiberi III MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research. Informed consent was deemed unnecessary by our institutional review board.

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Tiberi, J.V., Hansen, V., El-Abbadi, N. et al. Increased Complication Rates After Hip and Knee Arthroplasty in Patients With Cirrhosis of the Liver. Clin Orthop Relat Res 472, 2774–2778 (2014). https://doi.org/10.1007/s11999-014-3681-z

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  • DOI: https://doi.org/10.1007/s11999-014-3681-z

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