Abstract
Introduction
Survival after contemporary solid organ transplant (SOT) is increasing, and demand for total hip arthroplasty (THA) among SOT recipients is rising accordingly. The purpose of this study is to compare the perioperative outcomes and short-term implant- and patient-survivorship of contemporary THA following the most common types of SOT.
Methods
Among SOT recipients, 119 primary THAs (92 patients, 39% female) were performed at a single institution from 2000–2020 and were retrospectively reviewed at a mean follow-up of 3.6yrs. Revisions, conversion to THA and multiple organs transplanted were excluded. The most common SOT was renal (39%), followed by lung (34%), liver (18%) and heart (8%). Demographics, peri-operative outcomes, 90-day re-admissions, re-operations and mortality were compared between SOT groups using chi-squared, Fisher's exact, Wilcoxon tests and Cox proportional hazard ratios.
Results
Renal (median: 52yrs, 25–75%ile: 45.1–58.1) and heart transplant patients (55.4, 53.8–68.8) presented for THA at younger ages than liver (62.8, 50.0–67.6) and lung patients (63.1, 55.4–69.0; p<0.001). However, renal patients had the longest duration between SOT and THA (8.2yrs, 2.8–13.7; p=0.002), followed by liver (5.0, 1.2–11.4), heart (4.2, 2.4–9.6) and lung (2.6, 1.3–5.5). LOS was 3.0 days (p=0.31), 16% were discharged to a facility (p=0.87), and 9.4% required transfusion (p=0.43). Eighteen patients required re-admission within 90days (15%; p=0.44), and four underwent revision at 1-yr (3.4%; p=0.42). Mortality was 4.3% at 1yr (95% CI: 1.6–10.9) and 23.1% at 3yrs (95% CI: 15.0–32.9). When adjusted for age, ASA class, and duration from SOT to THA, lung transplant had higher mortality relative to kidney (RR 4.28, 95% CI: 1.79–11.26; p<0.001) and liver (RR 5.84, 95% CI: 1.95–25.29; p<0.001).
Conclusion
SOT patients are a medically complex group with substantial requirements for facility placement, transfusions and re-admissions after THA. Short-term implant survivorship is acceptable, but THA in SOT patients is not without mortality risk, especially among lung transplant recipients.
