University of Virginia Health System, Department of Orthopaedic Surgery, Charlottesville, Virginia.
J Bone Joint Surg Am. 2022 Apr 6;104(Suppl 2):76-83. doi: 10.2106/JBJS.20.00397.
Osteonecrosis of the femoral head (ONFH) is a potentially debilitating condition, often requiring total hip arthroplasty (THA). Patients with solid organ transplant (SOT) are at increased risk of postoperative complications after THA for osteoarthritis. The objective of the present study is to evaluate SOT as a potential risk factor for complication after THA for ONFH.
This is a retrospective study that identified patients with SOT who underwent THA for ONFH from 2005 to 2014 in a national insurance database and compared them to 5:1 matched controls without transplant. Subgroup analyses of patients with renal transplant (RT) and those with non-RT were also analyzed. A logistic regression analysis was used to compare rates of mortality, hospital readmission, emergency room (ER) visits, infection, revision, and dislocation while controlling for confounders. Differences in hospital charges, reimbursement, and length of stay (LOS) were also compared.
996 patients with SOT who underwent THA were identified and compared to 4,980 controls. SOT patients experienced no increased risk of early postoperative complications compared to controls. Solid organ transplant was associated with higher resource utilization and LOS. Renal transplant patients were found to have significantly higher risk of hospital readmission at 30 days (odds ratio [OR] 1.77; p = 0.001) and 90 days (OR 1.62; p < 0.001) and hospital LOS (p < 0.001), but had lower risk of infection (OR 0.65; p = 0.030). Non-RT patients had higher rate of ER visits at 30 days (OR 2.26; p = 0.004) but lower rates of all-cause revision (OR 0.22; p = 0.043).
Patients with history of SOT undergoing THA for ONFH utilize more hospital resources with longer LOS and greater risk of readmission but are not necessarily at an increased risk of early postoperative complications.
股骨头坏死（ONFH）是一种潜在的使人虚弱的疾病，通常需要全髋关节置换术（THA）。接受实体器官移植（SOT）的患者在因骨关节炎接受 THA 后发生术后并发症的风险增加。本研究的目的是评估 SOT 是否为 ONFH 患者 THA 后发生并发症的潜在危险因素。
这是一项回顾性研究，在国家保险数据库中确定了 2005 年至 2014 年间接受 SOT 治疗的 ONFH 患者，并将其与未接受移植的 5：1 匹配对照进行比较。还对接受肾移植（RT）和非 RT 的患者进行了亚组分析。使用逻辑回归分析来比较死亡率、医院再入院、急诊室（ER）就诊、感染、翻修和脱位的发生率，同时控制混杂因素。还比较了住院费用、报销和住院时间（LOS）的差异。
共确定了 996 例接受 SOT 治疗的患者，并与 4980 例对照进行了比较。与对照组相比，SOT 患者术后早期并发症的风险无增加。实体器官移植与更高的资源利用率和 LOS 相关。肾移植患者在 30 天（优势比 [OR] 1.77；p = 0.001）和 90 天（OR 1.62；p < 0.001）以及住院 LOS（p < 0.001）时的再入院风险显著增加，但感染风险较低（OR 0.65；p = 0.030）。非 RT 患者在 30 天时有更高的急诊就诊率（OR 2.26；p = 0.004），但全因翻修率较低（OR 0.22；p = 0.043）。
接受 SOT 治疗的 ONFH 患者接受 THA 后，利用更多的医院资源，LOS 更长，再入院风险更高，但不一定会增加术后早期并发症的风险。
