Revision Total Hip Arthroplasty in Solid Organ Transplant Patients: A Propensity Score-Matched Cohort Study for Aseptic and Infected Revisions.

Alex Upfill-Brown,Christos Photopoulos,Kadarius Burgess,Clark J. Chen,Amir Khoshbin,Christopher M. Hart,Peter P. Hsiue,Alexandra I. Stavrakis

doi:10.1016/j.artd.2021.10.007

Abstract

BackgroundPrevious studies have demonstrated that solid organ transplant (SOT) patients undergoing primary total hip arthroplasty (THA) are at an increased risk of postoperative complications. The purpose of this study is to use a large, national database to investigate revision THA (rTHA) outcomes in SOT patients.MethodsNationwide Readmissions Database (NRD) from 2010-2018 was used, and ICD-9 and ICD-10 codes were used to identify all patients who underwent rTHA, including those with history of SOT. Propensity score matching (PSM) was used to analyze rTHA outcomes in SOT patients comparted to matched controls. Separate analysis performed for patients undergoing rTHA for prosthetic joint infection (PJI) vs other causes.ResultsA total of 414,756 rTHA, with 1837 of those being performed in SOT patients, were identified. Of these, 65,961 and 276 were performed for PJI in non-SOT and SOT patients, respectively. For non-PJI patients, SOT patients had higher 90-day all-cause readmission rates (24.0% vs 19.4%, P = .03) but lower rate for readmission related to rTHA (6.0% vs 9.2%, P = .03), but no difference readmission for specific rTHA complications, mortality (0.6% vs 1.3%, P = .20), or revision rTHA. Of PJI patients, SOT patients had no difference in overall 90-day readmission (38.6 vs 31.3%, P = .280), readmission for specific rTHA complications, re-revision, or mortality (4.7% vs 6.0%, P = .63).ConclusionsSOT patients undergoing rTHA for aseptic reasons are higher risk of overall readmission but lower risk of readmission related to rTHA than appropriately matched controls. SOT PJI patients undergoing had similar rates of readmission, mortality, and revision surgery compared to matched non-SOT PJI patients.

Highlights

Total hip arthroplasty (THA) has long been established as a safe and effective treatment for hip arthritis with significant benefits forNo author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work
We found no difference in 90-day mortality for solid organ transplant (SOT) patients undergoing revision THA (rTHA) for prosthetic joint infection (PJI) (4.7% vs 6.0%) or for other causes (0.6% vs 1.3%)
SOT patients are more likely to be treated at specialized academic centers, and as we find in this study, are more likely to receive their arthroplasty care at these same institutions

Summary

Introduction

Total hip arthroplasty (THA) has long been established as a safe and effective treatment for hip arthritis with significant benefits forNo author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. Previous studies have demonstrated that solid organ transplant (SOT) patients undergoing primary total hip arthroplasty (THA) are at an increased risk of postoperative complications. For non-PJI patients, SOT patients had higher 90-day all-cause readmission rates (24.0% vs 19.4%, P 1⁄4 .03) but lower rate for readmission related to rTHA (6.0% vs 9.2%, P 1⁄4 .03), but no difference readmission for specific rTHA complications, mortality (0.6% vs 1.3%, P 1⁄4 .20), or revision rTHA. Of PJI patients, SOT patients had no difference in overall 90-day readmission (38.6 vs 31.3%, P 1⁄4 .280), readmission for specific rTHA complications, re-revision, or mortality (4.7% vs 6.0%, P 1⁄4 .63).

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