To the editor,
We read the study by Tiberi and colleagues with great interest. The authors analyzed the increased complication rates after hip and knee arthroplasty in patients with cirrhosis of the liver. The results indicated that a Model for End-stage Liver Disease (MELD) score of 10 or greater is associated with a high rate of complications [3]. We congratulate the authors on their work, which adds to our knowledge and understanding of the relatively difficult clinical problem. However, we would like to share some of the concerns we have regarding this paper.
As skeletal trauma doctors, we know that hemiarthroplasty is more suitable than internal fixation and THA for a considerable proportion of inactive patients with nondisplaced and displaced femoral neck fractures due to osteoporosis and serious medical illnesses [3]. This is also a standard rule for patients with osteoarthritis who need a THA. We believe that patients with arthritis who also have severe medical problems such as cirrhosis might benefit from hemiarthroplasty rather than THA, since the former may be a smaller, shorter surgery with less blood loss [2]. However, in the study by Tiberi and colleagues, 65 patients with liver cirrhosis underwent THA [4], and the overall mortality rates were as high as 27%. We wondered why the authors did not choose hemiarthroplasty for such patients, which may have resulted in a relatively lower mortality. As we know, THA may be best used conservatively, and only in the healthiest patients, in order to avoid higher initial costs and complication rates [1]. Interestingly, there have been a series of physiologic status score systems to help us choose between hemiarthroplasty or THA. According to those physiologic status score systems, hemiarthroplasty is the better fit for patients with cirrhosis of the liver, especially for patients with a MELD score of 10 or higher [1].
Footnotes
(RE: Tiberi JV 3rd, Hansen V, El-Abbadi N, Bedair H. Increased complication rates after hip and knee arthroplasty in patients with cirrhosis of the liver. Clin Orthop Relat Res. 2014;472:2774–2778).
Each author certifies that they, or any member of his or her immediate family, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®.
References
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