Increased rates of periprosthetic joint infection in patients with cirrhosis undergoing total joint arthroplasty.
BACKGROUND
Total joint arthroplasty (TJA) is becoming more prevalent, with additional increases in procedure rates expected as the US population ages. Small series have suggested increased risk of periprosthetic joint infections in patients with liver cirrhosis after TJA. However, the rates of periprosthetic joint infections and use of TJA for patients with cirrhosis have not been evaluated on a larger scale.


OBJECTIVE
The purposes of this study were to (1) measure the rate of periprosthetic joint infections after THAs and TKAs in patients with cirrhosis of the liver; (2) assess mortality, length of hospital stay, readmission rates, and other clinical factors among patients with cirrhosis who have had a TJA; and (3) evaluate the use of TJA in the United States among patients with liver cirrhosis during the past decade.


METHODS
National and state-level databases were used to identify patients with and without liver cirrhosis who underwent TJAs. The rate of periprosthetic joint infections within 6 months was assessed using the Statewide Inpatient Database, which identified 306,946 patients undergoing THAs (0.3% with cirrhosis) and 573,840 patients undergoing TKAs (0.2% with cirrhosis). To evaluate trends in the use of TJAs, 16,634 patients with cirrhosis who underwent TJAs were identified from the Nationwide Inpatient Sample from 2000 to 2010.


RESULTS
Periprosthetic joint infections after THA were more common in patients with cirrhosis for hip fracture (6.3% versus 1.1%; hazard ratio [HR], 5.8; p < 0.001) and nonhip fracture diagnoses (3.7% versus 0.7%; HR, 5.4; p < 0.001). Periprosthetic joint infections were more common after TKA in patients with cirrhosis (2.7% versus 0.8%; HR, 3.4; p < 0.001). Use of TJA increased faster for patients with cirrhosis than for patients without cirrhosis for THAs (140% versus 80%; p = 0.011) and TKAs (213% versus 128%; p < 0.001), and also increased faster than the general increase in use of TJAs.


CONCLUSIONS
Periprosthetic joint infections were more common among patients with cirrhosis who had TJAs. Additionally, patients with cirrhosis had longer length of hospital stay, increased costs, and higher rates of mortality, readmission, and reoperation. Finally, national use of TJAs for patients with cirrhosis has increased during the past decade.


METHODS
Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA, 94143-0728, USA.
Shirley L
SL
Jiang
William W
WW
Schairer
Kevin J
KJ
Bozic
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation* / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000191:economics; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects* / Q000191:economics; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000191:economics / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States