Total Hip Arthroplasty in Solid Organ Transplant Patients - Case Series

Background: Patients undergoing Solid Organ Transplantation (SOT) have an increased fracture risk and are prone to Avascular osteonecrosis (AVN). With the development of postoperative protocols, surgical techniques and healthcare systems, the number of patients with SOT and degenerative joint disease is steadily increasing. The aim of the present study was to determine the surgical outcomes in a series of kidney and liver graft recipients who underwent Total Hip Arthroplasty (THA) for various indications. Methods: This review examines our experience with THA in patients with end-stage kidney and liver disease following SOT at a single center. From 2017 to 2023, 11 THAs were performed. Surgery was performed after ineffective conservative treatment. All patients underwent extended preoperative preparation and were cleared for surgery by their transplant specialist. The surgical approach was the lateral Hardinge approach. An uncemented press-fit technique was preferred in 9 cases, while 2 were cemented. Patients were examined at 2 weeks, 1 month, 2 months and 6 months after surgery. All patients were evaluated using the Harris Hip Score (HHS) and Visual Analogue Scale (VAS). Results: We performed 11 THAs in a group of 5 kidney and 5 liver transplant recipients. The time between organ transplantation and joint replacement averaged approximately 4 years. Surgical indications were osteoarthritis, AVN and femoral neck fracture. Cemented prosthetic components were used in 2 cases, while uncemented components were used in the remaining 9 cases. Two patients experienced complications and required revision surgeries. The average improvement in the HHS score postoperatively was 42 points, and the VAS score improved by 37 points. Conclusion: THA in transplant recipients significantly improves joint function and quality of life, particularly in cases of avascular necrosis and osteoarthritis. While complications may occur, careful patient selection and thorough preoperative preparation result in substantial postoperative improvements.