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Total knee arthroplasty in patients with liver cirrhosis
Lih-Yuann Shih1, Chun-Ying Cheng, Chung-Hsun Chang
1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kweishan, 333 Taoyuan, Taiwan, Republic of China. aronc@adm.cgmh.org.tw
Insights
Total knee arthroplasty in patients with liver cirrhosis leads to significantly higher complications, longer hospital stays, and increased mortality. Avoid surgery in patients with hepatic decompensation or variceal bleeding history.
Area of Science:
- Orthopaedic Surgery
- Hepatology
- Gastroenterology
Background:
- Liver cirrhosis increases surgical risks, but elective orthopaedic procedures in these patients are understudied.
- This study investigates the outcomes and risks of total knee arthroplasty (TKA) in patients with cirrhosis.
Purpose of the Study:
- To review TKA outcomes in patients with liver cirrhosis.
- To identify risk factors associated with poor results after TKA in this population.
Main Methods:
- Retrospective review of 60 TKAs in 51 patients with cirrhosis compared to matched controls.
- Evaluation of complications, mortality, and risk factors for poor outcomes.
Main Results:
- TKA patients with cirrhosis experienced significantly more blood loss, longer hospital stays, higher complication rates (21% infection), and increased mortality compared to controls.
- Hepatic decompensation or variceal bleeding history predicted complications; age, low platelet count, and hepatitis B-related cirrhosis predicted infection.
- Hepatoma presence significantly predicted mortality; no perioperative deaths occurred.
Conclusions:
- TKA complication rates are significantly higher in cirrhotic patients.
- TKA is not recommended for patients with a history of hepatic decompensation or variceal bleeding.
- Child class-A cirrhotic patients without specific risk factors may benefit from TKA, but risks must be carefully weighed.
Background:
Patients with liver cirrhosis have an increased risk of surgical morbidity and mortality. We are aware of no study that has investigated the risks and outcomes of elective orthopaedic procedures in these patients. The purposes of the present study were to review the results of total knee arthroplasty in patients with cirrhosis and to identify risk factors leading to poor results.
Methods:
Fifty-one patients with cirrhosis who had undergone sixty total knee arthroplasties for osteoarthritis were studied. The medical records and laboratory data were collected retrospectively. All data were compared with those for matched patients without cirrhosis. Forty-two patients (fifty-one knees) with complete follow-up were evaluated with regard to complications, mortality, and factors leading to poor results.
Results:
Total knee arthroplasty was associated with significantly more blood loss, a longer hospital stay, more complications, and a higher mortality rate in patients with cirrhosis as compared with control patients (p
Conclusions:
The rate of complications after total knee arthroplasty was significantly higher in patients with cirrhosis than in control patients (p < 0.001). We believe that total knee arthroplasty should not be performed in patients with a history of hepatic decompensation or variceal bleeding. The risk of infection was high in older patients, patients with a low platelet count, and patients in whom the cirrhosis was related to the hepatitis-B virus. Aggressive prophylaxis against infection should be performed. Patients with Child class-A cirrhosis without these risk factors may do well following a total knee arthroplasty. The benefit of total knee arthroplasty should be cautiously weighed against its potential risks in patients with cirrhosis.
