# Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis

## TL;DR

This study finds that patients who have had solid organ transplants face higher risks of complications after hip or knee replacement surgery compared to the general population.

## Contribution

The study provides a systematic review and meta-analysis of complication risks in solid organ transplant patients undergoing total hip or knee arthroplasty.

## Key findings

- Solid organ transplant patients had higher rates of blood transfusion, infection, and DVT after hip and knee surgery.
- Kidney transplant patients faced higher early mortality and re-admission rates after hip surgery.
- Periprosthetic fracture risk was higher after knee surgery but not hip surgery in transplant patients.

## Abstract

This systematic review and meta-analysis aimed to quantify risks of complications associated with total hip and knee arthroplasty (THA, TKA) in patients with solid organ transplants (SOT) compared to the general population.

The study was pre-registered on PROSPERO (CRD42023399043). Literature searches were performed looking for comparative studies reporting postoperative complication data of THA or TKA in patients with kidney, liver, pancreas, heart, or lung transplants versus controls. Outcomes of interest included incidence of blood transfusion, periprosthetic joint infection (PJI), periprosthetic fracture, deep venous thrombosis (DVT), pulmonary embolism (PE), mortality, hospital re-admission, and all-cause revision. The Newcastle Ottawa scale was used to assess study quality, and the GRADE for certainty of evidence.

A total of 13 studies participated in meta-analyses (10 in THA, 3 in TKA). Compared to controls, SOT patients (mixed data from all transplant types) had a significantly higher incidence of blood transfusion [THA OR 1.57 (1.36–1.80), TKA OR 1.37 (1.15–1.63)], PJI [THA OR 1.78 (1.01–3.12), TKA 3.11 (1.16–8.35)], DVT [THA OR 1.32 (1.04–1.66), TKA OR 1.56 (1.36–1.78)], and all-cause revision [only TKA OR 1.37 (1.15–1.63)]. THA in kidney transplant patients was associated with higher early mortality [OR 2.12 (1.38–3.25)] and 30-day re-admission [OR 1.62 (1.31–2.00)] compared to the general population. SOT was not associated with a higher incidence of post-operative PE after either THA or TKA [OR 0.94 (0.66–1.34), OR 0.89 (0.55–1.43), respectively]. The incidence of THA dislocation in mixed analyses with all SOT types was not statistically significant despite the unfavourable OR [1.62 (0.94–2.78)], but it was in the kidney and heart transplant subgroup analyses (OR 1.41 (1.16–1.73), OR 2.17 (1.47–3.20), respectively). The incidence of periprosthetic fracture was not higher in SOT patients compared to controls in those undergoing a THA [OR 1.07 (0.84–1.36)], but it was after a TKA [OR 1.79 (1.36–2.36)].

THA and TKA are associated with an unfavourable complication profile in SOT patients compared to the general population. Decisions for or against arthroplasty surgery should be made on an individual basis with a multidisciplinary approach.

The online version contains supplementary material available at 10.1186/s42836-025-00343-w.