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Total hip arthroplasty in patients with chronic liver disease: A systematic review

Introduction: Chronic liver disease (CLD) is a significant and increasingly prevalent co-morbidity in patients undergoing total hip arthroplasty (THA). These patients may develop metabolic bone disease (MBD) and systemic dysfunction, which pose challenges to THA surgery. This systematic review of li...

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Autores principales: Onochie, Elliot, Kayani, Babar, Dawson-Bowling, Sebastian, Millington, Steven, Achan, Pramod, Hanna, Sammy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824439/
https://www.ncbi.nlm.nih.gov/pubmed/31674904
http://dx.doi.org/10.1051/sicotj/2019037
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author Onochie, Elliot
Kayani, Babar
Dawson-Bowling, Sebastian
Millington, Steven
Achan, Pramod
Hanna, Sammy
author_facet Onochie, Elliot
Kayani, Babar
Dawson-Bowling, Sebastian
Millington, Steven
Achan, Pramod
Hanna, Sammy
author_sort Onochie, Elliot
collection PubMed
description Introduction: Chronic liver disease (CLD) is a significant and increasingly prevalent co-morbidity in patients undergoing total hip arthroplasty (THA). These patients may develop metabolic bone disease (MBD) and systemic dysfunction, which pose challenges to THA surgery. This systematic review of literature aims to examine clinical outcomes and complications in patients with CLD undergoing THA and provide evidence-based approaches as to the optimization of their perioperative care. Methods: A Pubmed search was performed, identifying eight studies on 28 514 THAs for inclusion. Two additional studies reported on 44 patients undergoing THA post liver transplant. These were reviewed separately. Results: Increased early perioperative complications are reported recurrently. Review of long-term complications demonstrates an increased postoperative infection rate of 0.5% (p < 0.001) and perioperative mortality of 4.1% (p < 0.001). The need for revision surgery is more frequent at 4% (p < 0.001). Aetiology of need for revision surgery included; periprosthestic infection (70%), aseptic loosening (13%), instability (13%), periprosthetic fracture (2%) and liner wear (2%). THA in patients with liver transplants seems to offer functional improvement; however, no studies have formally assessed functional outcomes in the patient with active CLD. Discussion: A multidisciplinary perioperative approach is suggested in order to minimize increased complication risks. Specific measures include optimizing haemoglobin and taking measures to reduce infection. This review also highlights gaps in available literature and guides future research to appraise functional outcomes, further detail long-term failure reasons and study any differences in outcomes and complications based on the range of operative approaches and available implant choices.
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spelling pubmed-68244392019-11-13 Total hip arthroplasty in patients with chronic liver disease: A systematic review Onochie, Elliot Kayani, Babar Dawson-Bowling, Sebastian Millington, Steven Achan, Pramod Hanna, Sammy SICOT J Review Article Introduction: Chronic liver disease (CLD) is a significant and increasingly prevalent co-morbidity in patients undergoing total hip arthroplasty (THA). These patients may develop metabolic bone disease (MBD) and systemic dysfunction, which pose challenges to THA surgery. This systematic review of literature aims to examine clinical outcomes and complications in patients with CLD undergoing THA and provide evidence-based approaches as to the optimization of their perioperative care. Methods: A Pubmed search was performed, identifying eight studies on 28 514 THAs for inclusion. Two additional studies reported on 44 patients undergoing THA post liver transplant. These were reviewed separately. Results: Increased early perioperative complications are reported recurrently. Review of long-term complications demonstrates an increased postoperative infection rate of 0.5% (p < 0.001) and perioperative mortality of 4.1% (p < 0.001). The need for revision surgery is more frequent at 4% (p < 0.001). Aetiology of need for revision surgery included; periprosthestic infection (70%), aseptic loosening (13%), instability (13%), periprosthetic fracture (2%) and liner wear (2%). THA in patients with liver transplants seems to offer functional improvement; however, no studies have formally assessed functional outcomes in the patient with active CLD. Discussion: A multidisciplinary perioperative approach is suggested in order to minimize increased complication risks. Specific measures include optimizing haemoglobin and taking measures to reduce infection. This review also highlights gaps in available literature and guides future research to appraise functional outcomes, further detail long-term failure reasons and study any differences in outcomes and complications based on the range of operative approaches and available implant choices. EDP Sciences 2019-11-04 /pmc/articles/PMC6824439/ /pubmed/31674904 http://dx.doi.org/10.1051/sicotj/2019037 Text en © The Authors, published by EDP Sciences, 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Onochie, Elliot
Kayani, Babar
Dawson-Bowling, Sebastian
Millington, Steven
Achan, Pramod
Hanna, Sammy
Total hip arthroplasty in patients with chronic liver disease: A systematic review
title Total hip arthroplasty in patients with chronic liver disease: A systematic review
title_full Total hip arthroplasty in patients with chronic liver disease: A systematic review
title_fullStr Total hip arthroplasty in patients with chronic liver disease: A systematic review
title_full_unstemmed Total hip arthroplasty in patients with chronic liver disease: A systematic review
title_short Total hip arthroplasty in patients with chronic liver disease: A systematic review
title_sort total hip arthroplasty in patients with chronic liver disease: a systematic review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824439/
https://www.ncbi.nlm.nih.gov/pubmed/31674904
http://dx.doi.org/10.1051/sicotj/2019037
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