title: Complications of total hip arthroplasty following solid organ transplantation.
abstract: OBJECTIVE
  Solid organ transplants (SOT) continue to increase with recipients living longer than ever before. The lifelong immunosuppression in these patients also may place them at increased risk for postoperative complications. The efficacy of total hip arthroplasty (THA) in this patient population is undisputed but previous studies investigating the complication profiles in these patients often are underpowered to identify rare complications as well as make comparisons between individual organs. The purpose of this study was to use a large database to compare complications of a combined SOT cohort as well as each individual organ to a control population.
  
  
  METHODS
  A search of the entire Medicare database from 2005 to 2011 was performed using International Classification of Disease version 9 (ICD-9) codes to identify patients who underwent THA after one or more solid organ transplants. A large cohort of patients served as a control with minimum 2-year follow-up. Post-operative complications at 30-day, 90-day, and overall time points were investigated.
  
  
  RESULTS
  Transplant patients carry more medical comorbidities and are prone to increased medical complications, dislocations (OR 1.45, p < 0.001), need for irrigation and debridement (OR 1.90, p < 0.001), and periprosthetic infection (OR 1.69, p < 0.001) compared to patients without SOT. Total hip arthroplasty after renal transplantation has the worst complication profile of the individual organs whereas lung and pancreas transplants were no different than control with regard to overall surgical complications.
  
  
  CONCLUSIONS
  The complications of THA after SOT vary by individual organ and these results may aid in patient selection and perioperative patient counseling.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: Mitchell.klement@dm.duke.edu.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Klement
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: colin.penrose@duke.edu.
authors.forename: Colin T
authors.initials: CT
authors.lastname: Penrose
authors.affiliation: Department of Orthopedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, United States. Electronic address: abibala@stanford.edu.
authors.forename: Abiram
authors.initials: A
authors.lastname: Bala
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, 7062 North Pavilion, Durham, NC 27705, United States. Electronic address: cindy.green@dm.duke.edu.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Green
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: Richard.mather@dm.duke.edu.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Mather
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: Samuel.wellman@dm.duke.edu.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wellman
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: Michael.bolognesi@dm.duke.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bolognesi
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States. Electronic address: Thorsten.seyler@dm.duke.edu.
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D015897:Comorbidity; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States