Perioperative complications and mid-term outcomes in total hip and knee joint arthroplasty among solid organ transplant recipients: lowest reoperation-free survival and patient survivorship in lung transplant recipients

TL;DR

Joint replacements in organ transplant patients show good implant survival but lung transplant recipients face higher risks of reoperation and death.

Contribution

Identifies lung transplant recipients as having the lowest reoperation-free survival and patient survivorship after joint replacement surgery.

Findings

Lung transplant recipients had the shortest reoperation-free survival with a hazard ratio of 6.9 for reoperation.

Lung transplant recipients had the lowest 5-year patient survivorship at 68.6%.

Implant survivorship was high at 97.5% across all solid organ transplant recipients.

Abstract

Performing total joint replacements (TJR) in patients with solid organ transplantations (SOT) is associated with an increased risk of complications and reoperation. The aim of this study is to report on implant survivorship, patient survivorship, and complication rates for total knee arthroplasty (TKA) and total hip arthroplasty (THA) performed in heart, lung, liver and kidney transplant recipients.

Forty patients with heart, lung, liver, or kidney transplants who underwent primary THA or TKA between January 1, 2013, and July 31, 2023, were included. Implant survivorship, reoperation-free survivorship, patient survivorship, and complication rates were compared between the subgroups.

At a mean follow-up of 5.18 years, Implant survivorship and reoperation-free survival for the entire cohort at the last follow-up were 97.5% and 85%, respectively. Kaplan–Meier survival estimates demonstrated 5- and 10-year reoperation-free survival rates of 86.5% (95% CI: 76%–98.4%) and 57.6% (95% CI: 25.6%–100%), respectively. The lung transplant group had the shortest reoperation-free survival, although not statistically significant (p = 0.07), a significantly higher risk of reoperation, with a hazard ratio (HR) of 6.9 (95% CI: 1.1–41.2, p = 0.04) and both the lowest 5-year patient survivorship at 68.6% (p = 0.04) and the highest risk of death after TJR with a HR of 7 (95% CI: 1.2–45.5, p = 0.03).

Patients with SOT exhibit excellent mid-term implant survivorship, with a rate of 97.5%. Lung transplant recipients show the lowest rates of both reoperation-free survival and overall patient survivorship compared to heart, kidney, and liver transplant recipients. Despite this, the 90-day complication rates are similar across all organ groups.

Figures