Abstract
Introduction: Chronic liver disease (CLD) is a significant and increasingly prevalent co-morbidity in patients undergoing total hip arthroplasty (THA). These patients may develop metabolic bone disease (MBD) and systemic dysfunction, which pose challenges to THA surgery. This systematic review of literature aims to examine clinical outcomes and complications in patients with CLD undergoing THA and provide evidence-based approaches as to the optimization of their perioperative care.Methods: A Pubmed search was performed, identifying eight studies on 28 514 THAs for inclusion. Two additional studies reported on 44 patients undergoing THA post liver transplant. These were reviewed separately.Results: Increased early perioperative complications are reported recurrently. Review of long-term complications demonstrates an increased postoperative infection rate of 0.5% (p < 0.001) and perioperative mortality of 4.1% (p < 0.001). The need for revision surgery is more frequent at 4% (p < 0.001). Aetiology of need for revision surgery included; periprosthestic infection (70%), aseptic loosening (13%), instability (13%), periprosthetic fracture (2%) and liner wear (2%). THA in patients with liver transplants seems to offer functional improvement; however, no studies have formally assessed functional outcomes in the patient with active CLD.Discussion: A multidisciplinary perioperative approach is suggested in order to minimize increased complication risks. Specific measures include optimizing haemoglobin and taking measures to reduce infection. This review also highlights gaps in available literature and guides future research to appraise functional outcomes, further detail long-term failure reasons and study any differences in outcomes and complications based on the range of operative approaches and available implant choices.
Highlights
Chronic liver disease (CLD) is the fifth most common cause of mortality worldwide and its prevalence is increasing [1]
Keywords used for the searches were “hip arthroplasty” OR “total hip arthroplasty” OR “total hip replacement” AND “Chronic Liver disease” OR “Liver Failure” OR “Cirrhosis” OR “Hepatitis”
Two further studies [19, 20] reported on outcomes of Total hip arthroplasty (THA) in patients post liver transplantation for CLD, and this was deemed an interesting group for comment separately
Summary
Chronic liver disease (CLD) is the fifth most common cause of mortality worldwide and its prevalence is increasing [1]. Hepatitis B and C viruses are the most common causes of CLD. Improvements in medical care have meant that patients with CLD are surviving longer. Total hip arthroplasty (THA) is indicated to treat debilitating symptoms of hip osteoarthritis, including in those patients with CLD, this following lifestyle modifications and medical management. Several causes of CLD such as Sarcoidosis and Haemochromatosis are themselves associated with joint pathology, which may require THA. Patients whose CLD is secondary to chronic alcohol excess, or who are on long-term corticosteroids
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