# Comparing outcomes of total hip arthroplasty between cirrhotic and non-cirrhotic patients through a propensity-matched analysis

## TL;DR

This study finds that patients with moderate-to-severe liver cirrhosis undergoing hip replacement surgery face higher risks of infection-related readmissions and revisions.

## Contribution

The novel contribution is identifying higher PJI-related readmission and revision risks in moderate-to-severe cirrhotic THA patients compared to non-cirrhotic and mild cirrhotic patients.

## Key findings

- Moderate-to-severe cirrhotic THA patients had significantly higher 30- and 90-day readmissions due to periprosthetic joint infection (PJI).
- Moderate-to-severe cirrhotic THA patients had higher 90-day and all-time revisions due to PJI.
- Overall 90-day reoperation and revision risks were similar between non-cirrhotic and cirrhotic THA patients.

## Abstract

The impact of liver cirrhosis on surgical outcomes is well-known. This study aimed to compare postoperative outcomes of total hip arthroplasty (THA) in patients with versus without cirrhosis.

A retrospective review was conducted of all patients who received a THA between 2012 and 2021 with a minimum of two years of clinical follow-up at a single, urban tertiary health center with lab results available to calculate Model for End-stage Liver Disease (MELD) scores. Using demographic variables, patients with and without cirrhosis underwent a 10:1 propensity score match. Short-term clinical outcomes were compared between cohorts. Cirrhotic patients were stratified based on their MELD score as mild (MELD < 10, n = 39) or moderate-to-severe (MELD ≥ 10, n = 10).

Of the 539 patients included in this study, 49 patients were in the cirrhotic group and 490 patients were in the non-cirrhotic group. Compared to non-cirrhotic and mild cirrhotic, moderate-to-severe cirrhotic THA patients had significantly higher incidence of 30-day (2.9% vs. 2.6% vs. 30.0%, p = 0.011) and 90-day readmissions (5.9% vs. 2.6% vs. 30.0%, p = 0.038) due to periprosthetic joint infection (PJI), and higher incidence of 90-day (3.1% vs. 2.6% vs. 20.0%, p = 0.024) and all-time revisions (1.4% vs. 5.1% vs. 20.0%, p = 0.016) due to PJI. There were no differences in overall 90-day reoperation (p = 0.115) and revision risk (p = 0.202) between non-cirrhotic, mild cirrhotic, and moderate-to-severe cirrhotic THA patients. Freedom from all-cause reoperations/revisions did not differ significantly (p = 0.479) between non-cirrhotic and cirrhotic THA patients at 120 months of follow-up.

Cirrhotic patients, particularly those categorized as moderate-to-severe, undergoing THA may have higher risk of having a readmission or revision for PJI. However, overall 90-day readmission and revision risk were similar between non-cirrhotic and cirrhotic patients. Future research with larger sample sizes and databases is needed to further risk stratify, optimize and counsel cirrhosis patients surrounding THA.