Surgical complications of total knee replacement after solid organ transplant: A systematic review of the literature

Background

Since the mid-twentieth century, solid organ transplantation has become established worldwide and conferred immense benefit to hundreds of thousands of patients. Comorbidities associated with end stage organ failure and the use of immunosuppressive treatment result in solid organ transplant patients (SOTP) commonly developing bone disease necessitating joint replacement. The increasing life span of SOTPs has also resulted in an increase in age related osteoarthritis. The aim of this literature review was to summarise the evidence available on outcomes following total knee replacements (TKR) in SOTP's.

Methods

A systematic search of the literature was performed by authors using PRISMA guidelines. A total of 10 papers were reviewed for this article. Data was extracted from the papers regarding complications specifically related to TKR.

Results

SOTP's are more susceptible to post-operative complications following TKR. Infection was the most common post-operative complication encountered (6.99%). Overall complication rate reported was 22.58%. Renal transplant patients have shown to have a higher infection rate when compared to liver patients. Mortality rate is increased in this patient group (5.91%). Post-operative knee scores show good to excellent clinical results.

Conclusion

This review of the literature has highlighted from the limited data that there is an increased risk of post-operative complications following TKR in SOTP's. Further data is required to more accurately quantify this risk. Despite this, the benefit to be gained from TKR may outweigh the proven increased risk.

Implications

When counselling solid organ transplant patients for TKR, information regarding the increased post-operative risk should be discussed. This may become a more common scenario as life expectancy following SOT increases.