Total Joint Arthroplasty In Patients With Liver Cirrhosis: A Systematic Review

Abstract

Background: Total hip arthroplaties (THAs) and total knee arthroplasties (TKAs) have proven themselves as effective surgical procedures. As a result, the number of such procedures performed is increasing. It is also likely that more cirrhotic patients will undergo THA or TKA. Purpose: We performed a systematic review to assess periprosthetic joint complications, infections, mortality, and the outcome of total joint arthroplasties in patients diagnosed with cirrhosis. Material and Methods: We researched Medline, EMBASE, and Cochrane databases to identify eligible prospective studies. This yielded 346 unique articles. 27 of these articles fit the inclusion criteria, and 7 articles remained eligible after in-depth reading. Demographic characteristics, adverse events, and clinical outcomes were manually extracted from the selected studies. Results: The 7 studies included a total of 2724 TJA of which 1276 were THA and 1448 were THK. 3 studies provided data on the severity of cirrhosis using Child-Turcotte-Pugh. 4.7 % of perioperative complications occurred in class A, 50% in class B, and 100% in class C with a mortality rate of 66.6%. 5 studies provided data on short term (30 days) mortality after TJA. Therefore, these studies showed that mortality in patients with cirrhosis, undergoing TJA, is greater than in noncirrhotic patients (1.13% vs 0.17%). The rate of infection varied from 3.1% to 22% in cirrhotic patients and 0.7% to 1.4% in non-cirrhotic patients. Conclusion: This present systematic review shows that total joint arthroplasty surgery of patients with cirrhosis results in increased postoperative morbidity and mortality compared to similar surgeries for noncirrhotic patients.