Impact of Liver Cirrhosis on Postoperative Outcomes Following Total Hip and Knee Arthroplasty a Systematic Review and Meta-Analysis Publisher



Asgari AM ; Shaker F ; Malekshahi M ; Tavakoli K ; Behroo F ; Pahlevanfallahy MT ; Kasaeian A
Source: Bone and Joint Open Published:2025

Abstract

Aims Cirrhosis is a known comorbidity that may influence outcomes following total joint replacement (TJR). This meta-analysis evaluates the impact of cirrhosis on postoperative complications and mortality after TJR. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Four databases were searched up to February 2025. Studies comparing the outcomes of TJR in cirrhotic versus non-cirrhotic patients were included. Data were analyzed using a random-effects model, and subgroup and sensitivity analyses were performed. Results A total of 12 studies, including 12.8 million TJR cases, were analyzed, with 111,011 cirrhotic patients. Cirrhosis was significantly associated with higher rates of mortality (odds ratio (OR) = 4.67, 95% CI 2.58 to 8.43), revision surgery (OR = 2.13, 95% CI 1.60 to 2.83), periprosthetic joint infection (OR = 2.61, 95% CI 2.11 to 3.21), implant failure (OR = 1.86, 95% CI 1.58 to 2.18), prosthetic fracture (OR = 1.89, 95% CI 1.19 to 3.01), transfusion (OR = 1.73, 95% CI 1.56 to 1.92), pneumonia (OR = 1.35, 95% CI 1.17 to 1.56), acute renal failure (OR = 2.16, 95% CI 1.35 to 3.46), readmission (OR = 1.93, 95% CI 1.70 to 2.20), and extended hospital stay (SMD = 0.49, 95% CI 0.28 to 0.69). Gastrointestinal complications (OR = 0.72) and pulmo-nary thromboembolism (OR = 0.25) were significantly lower. No significant differences were observed for wound complications, bleeding volume, operating time, venous thromboembolism, or cardiac events. Conclusion Cirrhotic patients undergoing TJR are at greater risk for mortality, complications, and healthcare resource use. These findings underscore the need for multidisciplinary preoperative evaluation and careful risk-benefit assessment to improve outcomes in this vulnerable population. © 2025 Asgari et al.