Archives of Orthopaedic and Trauma Surgery - 2026-03-09 - Journal Article
Comparing outcomes of total hip arthroplasty between cirrhotic and non-cirrhotic patients through a propensity-matched analysis.
Haider M, Khury F, Katzman J, Connolly P, Sarfraz A, Schwarzkopf R, Lajam CM
Topics
Key Takeaway
Moderate-to-severe cirrhosis (MELD ≥10) is associated with a 30% rate of 30-day and 90-day PJI-related readmission after THA, compared to 2.6–2.9% in non-cirrhotic and mild cirrhotic patients.
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Summary
This single-center retrospective study compared THA outcomes in cirrhotic versus non-cirrhotic patients using 10:1 propensity score matching, stratifying cirrhotics by MELD score (<10 vs. ≥10). Moderate-to-severe cirrhotics (MELD ≥10, n=10) had significantly higher 30-day PJI readmission (30.0% vs. 2.9%), 90-day PJI revision (20.0% vs. 3.1%), and all-time PJI revision (20.0% vs. 1.4%) compared to non-cirrhotics. Overall 90-day reoperation and all-cause revision-free survival at 120 months did not differ significantly between cirrhotic and non-cirrhotic cohorts.
Key Limitation
The moderate-to-severe cirrhosis subgroup (n=10) is critically underpowered, making all PJI-specific comparisons statistically fragile and insufficient to drive practice change.
Original Abstract
BACKGROUND
The impact of liver cirrhosis on surgical outcomes is well-known. This study aimed to compare postoperative outcomes of total hip arthroplasty (THA) in patients with versus without cirrhosis.
METHODS
A retrospective review was conducted of all patients who received a THA between 2012 and 2021 with a minimum of two years of clinical follow-up at a single, urban tertiary health center with lab results available to calculate Model for End-stage Liver Disease (MELD) scores. Using demographic variables, patients with and without cirrhosis underwent a 10:1 propensity score match. Short-term clinical outcomes were compared between cohorts. Cirrhotic patients were stratified based on their MELD score as mild (MELD < 10, n = 39) or moderate-to-severe (MELD ≥ 10, n = 10).
RESULTS
Of the 539 patients included in this study, 49 patients were in the cirrhotic group and 490 patients were in the non-cirrhotic group. Compared to non-cirrhotic and mild cirrhotic, moderate-to-severe cirrhotic THA patients had significantly higher incidence of 30-day (2.9% vs. 2.6% vs. 30.0%, p = 0.011) and 90-day readmissions (5.9% vs. 2.6% vs. 30.0%, p = 0.038) due to periprosthetic joint infection (PJI), and higher incidence of 90-day (3.1% vs. 2.6% vs. 20.0%, p = 0.024) and all-time revisions (1.4% vs. 5.1% vs. 20.0%, p = 0.016) due to PJI. There were no differences in overall 90-day reoperation ( p = 0.115) and revision risk ( p = 0.202) between non-cirrhotic, mild cirrhotic, and moderate-to-severe cirrhotic THA patients. Freedom from all-cause reoperations/revisions did not differ significantly ( p = 0.479) between non-cirrhotic and cirrhotic THA patients at 120 months of follow-up.
CONCLUSIONS
Cirrhotic patients, particularly those categorized as moderate-to-severe, undergoing THA may have higher risk of having a readmission or revision for PJI. However, overall 90-day readmission and revision risk were similar between non-cirrhotic and cirrhotic patients. Future research with larger sample sizes and databases is needed to further risk stratify, optimize and counsel cirrhosis patients surrounding THA.