Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

Abstract

In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023; 14: 784-790. It is well known that patients who have undergone a liver transplant (LT) may need to have a total hip arthroplasty (THA) or total knee arthroplasty (TKA) implanted. Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population. However, there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population (individuals without LT). Therefore, in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population. Therefore, future research should attempt to resolve this controversy.

Key Words: Liver transplant; Total knee arthroplasty; Total hip arthroplasty; Results; Mortality

Core Tip: The existing publications are contradictory regarding mortality rates in liver transplant patients undergoing total hip arthroplasty and total knee arthroplasty. Therefore, this controversy should be duly analyzed in future studies.

INTRODUCTION

Patients who have undergone a liver transplant (LT) may need to have a total hip arthroplasty (THA) or total knee arthroplasty (TKA) implanted. Considering the severity of the problem, several authors have analyzed the mortality of LT patients compared to the general population (patients without LT)[1-4].

THERE IS CONTROVERSY IN THE LITERATURE

In a recent article published by Ahmed et al[1] it was concluded that individuals with a history of LT experiencing TKA or THA had similar rates of mortality than individuals with no history of LT. However, there are three articles which contradict the conclusion of Ahmed et al[1].

In the systematic review and meta-analysis published in 2022 by Kim et al[2], individuals with a history of LT undergoing THA showed higher mortality rates than individuals with no history of LT.

In a retrospective review of total joint arthroplasty (TJA) after LT, Wu et al[3] stated that the mortality risk of patients with LT was considerable.

Ledford et al[4] also found higher mortality rates after TKA and THA in patients with a history of LT than in the general population.

CONCLUSION

The existing publications are contradictory regarding mortality rates in LT patients undergoing THA and TKA. Therefore, this controversy should be duly analyzed in future studies.