Survivorship and Outcomes of Hip Arthroplasty for Elective Care versus Fracture in Patients Who Have Solid Organ Transplant: Lung Transplant Patients Do Worse

Background: With continued improvement in patient outcomes following solid organ transplant (SOT), more SOT recipients may benefit from hip arthroplasty. This study sought to compare the perioperative complications and survivorship of SOT recipients undergoing hip arthroplasty for elective care versus for fracture. Methods: A single-institution retrospective review yielded 95 hip arthroplasty procedures (80 patients) performed between August 2016 and May 2023, with a mean follow-up of 35 months. The most common SOT was liver (47%), followed by kidney (31%) and lung (23%). Cases with an elective indication (69 hips) were compared to those with traumatic indications (26 hips). Perioperative complications and patient survivorship were compared between the groups and by transplant type. Results: Patient mortality at 1 year was 19.2% for the fracture group compared to 1.4% for the elective group (P = 0.006). For elective care, lung transplant recipients had a higher incidence of postoperative mortality at the final follow-up (27%) when compared to the liver (7%) and renal (0%) (P = 0.044). Hospital length of stay was less in the elective group (2.7 ± 3.1 versus 16.3 ± 21.2 days, P = 0.002), and more elective patients were discharged to home (85 versus 42%, P < 0.001), but there was no difference in the rate of 90-day hospital readmission (P = 0.91) or orthopaedic complications (13 versus 12%, P = 1.0). For fracture care, a preoperative surgical delay greater than 48 hour was more frequently observed for lung compared to liver transplant recipients (83 versus 13%, P = 0.010). Conclusions: Recipients of SOT undergoing hip arthroplasty for fracture experience longer hospitalizations and increased 1-year mortality compared to elective cases with a similar rate of orthopaedic complications and hospital readmissions. When evaluating by SOT type, lung transplant patients may have increased surgical delays for fracture care and postoperative mortality for elective care. Level of evidence: Level III.