Operative Risk of Total Hip and Knee Arthroplasty in Cirrhotic Patients Stanley Martin Cohen, MD, Helen S. Te, MD, and Josh Levitsky, MD Abstract: Limited data exist on the safety of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) in cirrhotic patients. We retrospectively reviewed outcomes of these procedures in cirrhotic patients and matched controls. Significant adverse outcomes occurred in 20.7% (6 of 29) of cirrhotic patients compared with 3.23% (3 of 93) of controls. No significant differences were seen between the groups for elective TKA or THA. However, 80% (4 of 5) of the cirrhotic patients undergoing emergent THA secondary to fracture had major complications, with a 60% (3 of 5) mortality rate. There was a trend toward worse overall outcome in cirrhotic patients with more advanced liver disease. In conclusion, primary THA or TKA can be safely performed electively in Child’s A and B cirrhotic patients. However, emergent THA to repair fractures in cirrhotic patients is associated with significantly increased morbidity and mortality. Key words: total hip arthroplasty, total knee arthroplasty, cirrhosis, Child-Pugh score. n 2005 Elsevier Inc. All rights reserved. Patients with liver disease and cirrhosis are at increased risk for osteopenia, traumatic bone frac- tures, and iatrogenic avascular necrosis. In addition, several causes of chronic liver disease are associated with arthropathies, including autoimmune hepati- tis, primary biliary cirrhosis, sarcoidosis, hemochro- matosis, and cryoglobulinemia from hepatitis B and C infections [1-11]. Elective total hip arthroplasty (THA) is considered safe in the general population, with morbidity and mortality rates reported as up to 9% and 0.95%, respectively [12-16]. Elective total knee arthroplasty (TKA) is also considered safe, with morbidity and mortality rates reported as up to 10.1% and 0.51%, respectively [17-22] However, emergent THA for hip fracture is associated with significantly higher morbidity and mortality rates, at up to 27% and 14%, respectively [23-26]. Although limited data exist on the safety of general surgery in cirrhotic patients, little is known about the risk and outcome of arthroplasty in cirrhotic patients. Only 1 uncontrolled study has evaluated the safety of hip arthroplasty in cirrhotic patients [27], and only 1 recent study has looked at the outcome of cirrhotic patients undergoing TKA [28]. Furthermore, there is no controlled study evaluating the safety and outcome of both THA and TKA in cirrhotic patients. The aim of this study was to assess the safety and outcome of primary TKA and THA in cirrhotic patients. Materials and Methods After receiving approval from our institutional review board, a retrospective analysis was per- formed for all cirrhotic patients undergoing primary The Journal of Arthroplasty Vol. 20 No. 4 2005 460 From the University of Chicago, Division of Gastroenterology, Liver Study Unit, Chicago, Illinois. Submitted October 28, 2003; accepted May 20, 2004. No benefits or funds were received in support of this study. Reprint requests: Stanley Martin Cohen, MD, Associate Professor of Medicine, Rush University Medical Center, Section of Hepatology, 1725 West Harrison Street, Suite 158, Chicago, IL 60612. n 2005 Elsevier Inc. All rights reserved. 0883-5403/04/2004-0008$30.00/0 doi:10.1016/j.arth.2004.05.004