Clinical outcomes of solid organ transplant patients after total joint arthroplasty: a propensity-matched analysis

Solid organ transplant (SOT) patients undergoing total joint arthroplasty (TJA) may be at higher risk for complications due to complex medical and surgical histories, chronic immunosuppressive medications, and significant ongoing comorbidities. This study aimed to evaluate postoperative outcomes following primary, elective TJA in patients with a history of SOT.

We retrospectively reviewed 53,043 primary, elective TJA patients from 2011 to 2025. Patients were screened for SOT history prior to TJA. All SOT patients were taking some form of immunosuppressive medication following their transplantation. Demographics, SOT details, and surgical data were obtained. SOT patients (n = 70) underwent a nearest-neighbor 1:3 propensity-score matching to non-SOT (NSOT) controls (n = 210) based on age, sex, smoking, Charlson Comorbidity Index, body-mass index, and TJA indication. Kidney transplants were most common (61.4%), followed by liver (24.3%), and heart (8.6%). Differences in surgical outcomes and postoperative complications between the patients were investigated using Chi-squared tests, independent t-tests and effect size (ES) estimates. Baseline characteristics did not differ between the groups (P > 0.05).

SOT patients had significantly longer hospital stays (92 vs. 51 h, P < 0.001, ES = 0.82), higher rates of discharge to skilled nursing facilities (SNF) (15.7% vs. 5.7%, P = 0.014, ES = 0.17) and all-cause 90 day readmissions (15.7% vs. 6.7%, P = 0.040, ES = 0.12), primarily driven by non-surgical reasons (14.3% vs. 4.3%, P = 0.010, ES = 0.16) compared to NSOT patients. All-cause revision rates were comparable between SOT and NSOT patients (4.3% vs. 3.8%, P = 0.999), including aseptic (2.9% vs. 1.9%, P = 0.642) and septic causes (1.4% vs. 1.9%, P = 0.999).

Despite higher rates of SNF discharge and non-surgical 90 day readmissions, SOT patients achieved similar all-cause, septic, and aseptic revision rates, compared to NSOT patients. These findings suggest that compared to well-matched comorbid controls, SOT patients can safely undergo elective TJA with comparable revision risk. Enhanced perioperative care may help reduce readmission risks in this complex population.