No Difference in Morbidity and Mortality After Total Joint Arthroplasty in Liver Transplant Recipients: A Propensity Score–Matched Analysis of a Nationwide, Population-Based Study Using Universal Healthcare Data

Background: Controversy remains regarding the outcomes after total joint arthroplasty (TJA) among patients with or without liver transplantation (LT). This study aimed at investigating the prevalence of TJA in patients after LT and comparing the morbidity and mortality with the non-LT group. Methods: We conducted a nationwide, population-based study, with data extracted from a universal health insurance database, based on the International Classification of Disease, Ninth Revision, Clinical Modification. Patients who underwent TJAs between January 2001 and December 2014 were included. Patients who had bilateral TJAs or a TJA before LT were excluded. A total of 43 patients with LT and 350,337 patients without LT were included. The analysis was implemented using data from all patients and those matched by 1-to-10 propensity score matching. Multivariable logistic regression was used to control confounding variables. Results: The prevalence of patients undergoing TJA after LT was 1.3% (43/3276). After propensity score matching, patients with LT were not associated with 30-day complications (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.93-1.03; P =.35), 30-day readmission rates (aOR, 0.93; 95% CI, 0.92-1.08; P =.87), 90-day complication rates (aOR, 0.95; 95% CI, 0.88-1.02; P =.16), 1-year infection rates (aOR, 1.04; 95% CI, 0.96-1.12; P =.35), reoperation rates (aOR, 1.06; 95% CI, 0.92-1.23; P =.41), or mortality (aOR, 0.91; 95% CI, 0.80-1.04; P =.18). Conclusion: The morbidity and mortality seem to be comparable whether TJA is performed in patients with or without LT. Methods for risk assessment would be feasible in liver transplant recipients.