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Updated: Aug 16, 2026
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Operative risk of total hip and knee arthroplasty in cirrhotic patients
Stanley Martin Cohen1, Helen S Te, Josh Levitsky
1University of Chicago, Division of Gastroenterology, Liver Study Unit, Chicago, IL, USA.
Insights
Elective total hip (THA) and knee (TKA) arthroplasty are safe for cirrhotic patients. However, emergent THA for fractures in this group carries high risks of complications and mortality.
Area of Science:
- Orthopedic Surgery
- Hepatology
- Gastroenterology
Background:
- Limited data exist on the safety of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients with liver cirrhosis.
- Cirrhotic patients represent a unique population with altered physiology that may impact surgical outcomes.
Purpose of the Study:
- To evaluate the safety and outcomes of primary THA and TKA in patients with liver cirrhosis.
- To compare adverse outcomes between cirrhotic patients and matched controls undergoing these procedures.
Main Methods:
- Retrospective review of patients who underwent primary THA or TKA.
- Comparison of outcomes between cirrhotic patients and a matched control group.
- Stratification of analysis based on elective versus emergent procedures and severity of liver disease (Child's classification).
Main Results:
- Overall, 20.7% of cirrhotic patients experienced significant adverse outcomes compared to 3.23% of controls.
- No significant differences in outcomes were observed for elective THA or TKA between groups.
- Emergent THA for fracture in cirrhotic patients showed 80% major complications and 60% mortality.
Conclusions:
- Elective primary THA and TKA can be safely performed in Child's A and B cirrhotic patients.
- Emergent THA for fracture repair in cirrhotic patients is associated with substantially increased morbidity and mortality.
- Advanced liver disease may correlate with worse surgical outcomes in this patient cohort.
Abstract:
Limited data exist on the safety of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) in cirrhotic patients. We retrospectively reviewed outcomes of these procedures in cirrhotic patients and matched controls. Significant adverse outcomes occurred in 20.7% (6 of 29) of cirrhotic patients compared with 3.23% (3 of 93) of controls. No significant differences were seen between the groups for elective TKA or THA. However, 80% (4 of 5) of the cirrhotic patients undergoing emergent THA secondary to fracture had major complications, with a 60% (3 of 5) mortality rate. There was a trend toward worse overall outcome in cirrhotic patients with more advanced liver disease. In conclusion, primary THA or TKA can be safely performed electively in Child's A and B cirrhotic patients. However, emergent THA to repair fractures in cirrhotic patients is associated with significantly increased morbidity and mortality.