Cirrhosis is associated with an increased risk of periprosthetic joint infection following total joint arthroplasty.

BACKGROUND

Liver transplant recipients and patients with cirrhosis are at increased risk of postoperative complications following total joint arthroplasty. However, the relationship between these conditions and periprosthetic joint infection (PJI) is unclear.

METHODS

The Premier Healthcare Database was used to identify adult patients who underwent elective total knee arthroplasty or total hip arthroplasty between 2016 and 2023. Patients with a history of liver transplantation (LT) or cirrhosis were subsequently identified. Cirrhosis and LT patients were 1:5 propensity matched to respective control patients without a history of either cirrhosis or LT. The 90-day adjusted odds of PJI were compared across cohorts using multivariable logistic regression.

RESULTS

In total, 943 LT patients and 5147 patients with cirrhosis were identified and matched to 4715 and 25,735 control patients, respectively. Patients with cirrhosis had a significantly increased adjusted odds of PJI compared to matched controls (adjusted odds ratio [aOR]: 2.90, 95%-confidence interval [CI]: 2.22-3.80, p < 0.001). However, no significant difference in adjusted odds of PJI was detected between LT patients and controls (aOR:1.04, 95%-CI: 0.34-3.20, p = 0.942).

CONCLUSION

Compared to control cohorts, patients with cirrhosis are at significantly increased risk of PJI following TJA. In contrast, no significant increase in risk of PJI was observed for LT patients compared to controls. However, given the limited number of PJI events in the LT cohort, a clinically meaningful effect cannot be excluded. The results of our current study are likely limited by sample size, number of PJI events, and statistical power, and should be interpreted with these limitations in mind. Our findings provide data to inform perioperative decision-making for TJA candidates with liver disease.