Revision Total Hip and Knee Arthroplasties After Solid Organ Transplant

Cameron K. Ledford, Joseph M. Statz, Brian P. Chalmers, Kevin I. Perry, Arlen D. Hanssen, Matthew Abdel

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: As solid organ transplant (SOT) patients' survival improves, the number undergoing total hip (THA) and total knee arthroplasty (TKA) is increasing. Accordingly, the number of revision procedures in this higher-risk group is also increasing. The goals of this study were to identify the most common failure mechanisms, associated complications, clinical outcomes, and patient survivorship of SOT patients after revision THA or TKA. Methods: A retrospective review identified 39 revision procedures (30 revision THAs and 9 revision TKAs) completed in 37 SOT patients between 2000 and 2013. The mean age at revision surgery was 62 years with a mean follow-up of 6 years. Results: The most common failure mode for revision THA was aseptic loosening (10/30, 33%), followed by periprosthetic joint infection (PJI; 7/30, 23%). The most common failure mode for revision TKA was PJI (5/9, 56%). There were 6 re-revision THAs for PJI (3/30; 10%) and instability (3/30; 10%). There were 2 reoperations after revision TKA, both for acute PJI (2/9; 22%). Final Harris Hip Scores significantly (P = .03) improved as did Knee Society Scores (P = .01). Estimated survivorship free from mortality at 5 and 10 years was 71% and 60% after revision THA and 65% and 21% after revision TKA, respectively. Conclusion: Revision THA and TKA after solid organ transplantation carry considerable risk for re-revision, particularly for PJI. Although SOT recipients demonstrate improved clinical function after revision procedures, patient survivorship at mid- to long-term follow-up is low.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jul 14 2016

Fingerprint

Tacrine
Knee Replacement Arthroplasties
Hip
Transplants
Survival Rate
Reoperation
Organ Transplantation
Joints
Survival
Mortality
Infection

Keywords

  • Aseptic loosening
  • Periprosthetic joint infection
  • Revision total hip arthroplasty
  • Revision total knee arthroplasty
  • Solid organ transplant

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Ledford, C. K., Statz, J. M., Chalmers, B. P., Perry, K. I., Hanssen, A. D., & Abdel, M. (Accepted/In press). Revision Total Hip and Knee Arthroplasties After Solid Organ Transplant. Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2016.11.047

Revision Total Hip and Knee Arthroplasties After Solid Organ Transplant. / Ledford, Cameron K.; Statz, Joseph M.; Chalmers, Brian P.; Perry, Kevin I.; Hanssen, Arlen D.; Abdel, Matthew.

In: Journal of Arthroplasty, 14.07.2016.

Research output: Contribution to journalArticle

Ledford, Cameron K. ; Statz, Joseph M. ; Chalmers, Brian P. ; Perry, Kevin I. ; Hanssen, Arlen D. ; Abdel, Matthew. / Revision Total Hip and Knee Arthroplasties After Solid Organ Transplant. In: Journal of Arthroplasty. 2016.
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abstract = "Background: As solid organ transplant (SOT) patients' survival improves, the number undergoing total hip (THA) and total knee arthroplasty (TKA) is increasing. Accordingly, the number of revision procedures in this higher-risk group is also increasing. The goals of this study were to identify the most common failure mechanisms, associated complications, clinical outcomes, and patient survivorship of SOT patients after revision THA or TKA. Methods: A retrospective review identified 39 revision procedures (30 revision THAs and 9 revision TKAs) completed in 37 SOT patients between 2000 and 2013. The mean age at revision surgery was 62 years with a mean follow-up of 6 years. Results: The most common failure mode for revision THA was aseptic loosening (10/30, 33{\%}), followed by periprosthetic joint infection (PJI; 7/30, 23{\%}). The most common failure mode for revision TKA was PJI (5/9, 56{\%}). There were 6 re-revision THAs for PJI (3/30; 10{\%}) and instability (3/30; 10{\%}). There were 2 reoperations after revision TKA, both for acute PJI (2/9; 22{\%}). Final Harris Hip Scores significantly (P = .03) improved as did Knee Society Scores (P = .01). Estimated survivorship free from mortality at 5 and 10 years was 71{\%} and 60{\%} after revision THA and 65{\%} and 21{\%} after revision TKA, respectively. Conclusion: Revision THA and TKA after solid organ transplantation carry considerable risk for re-revision, particularly for PJI. Although SOT recipients demonstrate improved clinical function after revision procedures, patient survivorship at mid- to long-term follow-up is low.",
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