Complications of total hip and knee arthroplasty in solid organ transplant patients: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: This systematic review and meta-analysis aimed to quantify risks of complications associated with total hip and knee arthroplasty (THA, TKA) in patients with solid organ transplants (SOT) compared to the general population. METHODS: The study was pre-registered on PROSPERO (CRD42023399043). Literature searches were performed looking for comparative studies reporting postoperative complication data of THA or TKA in patients with kidney, liver, pancreas, heart, or lung transplants versus controls. Outcomes of interest included incidence of blood transfusion, periprosthetic joint infection (PJI), periprosthetic fracture, deep venous thrombosis (DVT), pulmonary embolism (PE), mortality, hospital re-admission, and all-cause revision. The Newcastle Ottawa scale was used to assess study quality, and the GRADE for certainty of evidence. RESULTS: A total of 13 studies participated in meta-analyses (10 in THA, 3 in TKA). Compared to controls, SOT patients (mixed data from all transplant types) had a significantly higher incidence of blood transfusion [THA OR 1.57 (1.36-1.80), TKA OR 1.37 (1.15-1.63)], PJI [THA OR 1.78 (1.01-3.12), TKA 3.11 (1.16-8.35)], DVT [THA OR 1.32 (1.04-1.66), TKA OR 1.56 (1.36-1.78)], and all-cause revision [only TKA OR 1.37 (1.15-1.63)]. THA in kidney transplant patients was associated with higher early mortality [OR 2.12 (1.38-3.25)] and 30-day re-admission [OR 1.62 (1.31-2.00)] compared to the general population. SOT was not associated with a higher incidence of post-operative PE after either THA or TKA [OR 0.94 (0.66-1.34), OR 0.89 (0.55-1.43), respectively]. The incidence of THA dislocation in mixed analyses with all SOT types was not statistically significant despite the unfavourable OR [1.62 (0.94-2.78)], but it was in the kidney and heart transplant subgroup analyses (OR 1.41 (1.16-1.73), OR 2.17 (1.47-3.20), respectively). The incidence of periprosthetic fracture was not higher in SOT patients compared to controls in those undergoing a THA [OR 1.07 (0.84-1.36)], but it was after a TKA [OR 1.79 (1.36-2.36)]. CONCLUSION: THA and TKA are associated with an unfavourable complication profile in SOT patients compared to the general population. Decisions for or against arthroplasty surgery should be made on an individual basis with a multidisciplinary approach.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".