Increased Medical Complications Following Primary Total Hip Arthroplasty in Patients With Solid Organ Transplant: A Matched Cohort Analysis

Background: As patient longevity increases following solid organ transplantation (SOT), more transplant patients are undergoing total hip arthroplasty (THA). The purpose of this study is to compare 90-day postoperative complications and 2-year surgical complications following primary THA in patients with and without a history of SOT. Methods: Patients with a history of SOT with subsequent primary THA between 2010 and 2018 were identified in a national all-payer claims database (PearlDiver Technologies). This SOT cohort was propensity-matched with a control cohort (no history of SOT) based on age, gender, Charlson Comorbidity Index, and obesity with bivariate analysis to compare outcomes between cohorts. Results: Following matching, 3103 patients were included in the SOT cohort and 6196 patients in the control cohort. The cohorts were successfully matched, with no differences in demographics or comorbidities. Relative to the control cohort, patients with a history of SOT were at significantly increased risk of renal failure (P <.001), anemia (P <.001), arrhythmia with and without atrial fibrillation (P <.001), blood transfusion (P <.001), cellulitis (P =.048), myocardial infarction (P <.001), pneumonia (P =.036), heart failure (P <.001), and sepsis (P =.038) at 90 days postoperatively. There were no significant differences between the cohorts in 2-year surgical revisions, regardless of indication. Conclusion: Following primary THA, patients with a history of SOT are at increased risk of 90-day medical complications but not 2-year surgical complications or revisions relative to patients without SOT. Clinicians should be mindful of the increased risk for cardiopulmonary, renal, hematologic, and infectious complications when counseling and managing this patient population. Level of Evidence: Level IV-Retrospective Database Study.