Complications After Primary Total Joint Arthroplasty in Solid Organ Transplant Recipients.

BACKGROUND: The outcomes after total joint arthroplasty (TJA) for patients who have solid organ transplants (SOT) remain unclear. This study aimed to investigate: 1) overall medical and surgical complication rates, 2) survivorship-free rates from periprosthetic joint infection (PJI) and mortality specifically, and 3) risk factors for complications in SOT recipients undergoing TJA.

METHODS: A retrospective study was performed of all SOT recipients undergoing primary TJA at a single academic institution between 2005 and 2024, with a minimum one-year follow-up. Demographics, surgical characteristics, medical comorbidities, transplant type, and immunosuppressive therapy were recorded. We identified 103 TJAs (69 total hip arthroplasties [THA], 34 total knee arthroplasties [TKA]) in 89 SOT recipients who had a mean follow-up of 4.9 years. The overall complication rate was 26.2% (27 of 103). Logistic regression and Kaplan-Meier analyses were performed. An alpha level of 0.05 denoted significance.

RESULTS: The surgical and medical complication rates were 13.0 and 13.0% after THA, and 5.9 and 20.6% after TKA, respectively. After THA, five-year infection-free and mortality-free survivorships were 97.8 and 92.0%, respectively, with no difference by transplant type (P = 0.40 and P = 0.84, respectively). After TKA, five-year infection-free and mortality-free survivorships were 96.4 and 74.8%, respectively, with no difference by transplant type (P = 0.57 and P = 0.29, respectively). When controlling for confounders, body mass index (Odds Ratio [OR] 0.88, P = 0.02) and history of liver transplant (OR 0.21, P = 0.04) were associated with increased complications.

CONCLUSION: While overall complication rates were high, SOT recipients demonstrated low PJI rates following TJA when managed with multidisciplinary perioperative care. Only renal transplant recipients developed PJI, demonstrating potentially higher susceptibility in this subgroup. The mortality rates identified are concordant with literature describing general survivorship of patients after SOT and therefore appear to not be affected by undergoing TJA.