Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis

Background: The aim of this systematic review and meta-analysis was to quantify risks of complications associated with total hip and knee arthroplasty (THA, TKA) in patients with solid organ transplants (SOT) compared to the general population. Methods : The study was pre-registered on PROSPERO (CRD42023399043). Literature searches were performed looking for comparative studies reporting postoperative complication data of THA or TKA in patients with kidney, liver, pancreas, heart or lung transplants versus controls. Outcomes of interest included incidence of blood transfusion, periprosthetic joint infection (PJI), periprosthetic fracture, deep venous thrombosis (DVT), pulmonary embolism (PE), mortality, hospital re-admission and all-cause revision. The Newcastle Ottawa scale was used to assess study quality and the GRADE for certainty of evidence. Results : A total of 13 studies participated in meta-analyses (10 in THA, 3 in TKA). Compared to controls, SOT patients (mixed data from all transplant types) had a significantly higher incidence of blood transfusion [THA OR 1.57 (1.36–1.80), TKA OR 1.37 (1.15–1.63)], PJI [THA OR 1.78 (1.01–3.12), TKA 3.11 (1.16–8.35)], DVT [THA OR 1.32 (1.04–1.66), TKA OR 1.56 (1.36–1.78)], and all-cause revision [only TKA OR 1.37 (1.15-1.63)]. THA in kidney transplant patients was associated with higher early mortality [OR 2.12 (1.38-3.25)] and 30-day re-admission [OR 1.62 (1.31-2.00)] compared to the general population. SOT were not associated with a higher incidence of post-operative PE after either THA or TKA [OR 0.94 (0.66-1.34), OR 0.89 (0.55-1.43), respectively]. The incidence of THA dislocation in mixed analyses with all SOT types was not statistically significant despite the unfavourable OR [1.62 (0.94-2.78)] but it was in the kindey and heart transplant subgroup analyses (OR 1.41 (1.16-1.73), OR 2.17 (1.47-3.20), respectively. The incidence of periprosthetic fracture was not higher in SOT patients compared to controls in those undergoing a THA [OR 1.07 (0.84-1.36)], but it was after a TKA [OR 1.79 (1.36-2.36)]. Conclusion: THA and TKA is associated with an unfavourable complication profile in SOT patients compared to the general population. Decisions for or against arthroplasty surgery should be made on an individual basis with a multidisciplinary approach.