Hip and knee arthroplasty in solid organ transplant patients: Results from a Turkish government-based health registry

Objective: This national database study of a large cohort aimed to investigate the mortality and complication rates of patients with a his tory of solid organ transplantation (SOT) who underwent total knee arthroplasty (TKA), total hip arthroplasty (THA), or hemiarthroplasty (HA). Additionally, this study aimed to identify predictive factors for medical and surgical complications as well as mortality in this patient population.

Methods: This cohort study utilized data from the Turkish Ministry of Health to assess SOT patients undergoing TKA, THA, and HA. Propensity score matching was applied to create a comparable control group. Primary endpoints included medical and surgical complica tions within 90 days and mortality rates (in-hospital, at 1 month, 3 months, 1 year, and overall).

Results: Kidney transplantation was the most common type of transplant (n = 666, 81.5%), followed by  liver transplantation (n = 101, 12.4%). Revision rates were 4.5% in the SOT group and 3.9% in the control group (P = 0.472). SOT patients exhibited higher rates of medical complications, including chronic renal failure, pneumonia, electrolyte imbalances, urinary complications, and transfusion needs (P < 0.001). Mechanical complications were less frequent in the SOT group (2.57%) compared to the control group (3.7%), but prosthetic joint infection (PJI) rates were higher (2.57% vs. 1.4%, P = 0.035). Fracture history (HR: 4.82, 95% CI: 1.66-13.97, P = 0.004), chronic obstruc tive pulmonary disease (HR: 1.7, 95% CI: 1.17 2.46, P = 0.005), and age (HR: 1.034, 95% CI: 1.01-1.05, P < 0.001) were identified as indepen dent predictors of 90-day mortality. Patients undergoing HA experienced significantly higher mortality compared to TKA and THA (17.5%, 1.1%, and 1.7%, respectively; P < 0.001).

Conclusion: SOT patients undergoing joint arthroplasty have elevated risks of complications and mortality, particularly in the presence of fractures. Multidisciplinary management, perioperative optimization of modifiable comorbidities, and close monitoring may help mitigate these risks and improve patient outcomes.

Cite this article as: Kürşat Yılmaz M, Serdar Hakyemez Ö, Birinci M, et al. Hip and knee arthroplasty in solid organ transplant patients: results from a Turkish government-based health registry. Acta Orthop Traumatol Turc., 2025;59(6):452-457