Peri-operative treatment for total hip replacement in patients with hepatic cirrhosis

Xu Jie; Huang Jing; Ma Ruo-fan; Li Deng; Cai Zhi-qing; Li Liang-ping

doi:10.3969/j.issn.2095-4344.2013.52.005

Abstract：BACKGROUND:Hepatic cirrhosis may adversely affect the outcome of major orthopedic surgery, such as total hip arthroplasty. Peri-operative treatment is the chal enge for al orthopedic surgeons. <br> OBJECTIVE:To analyze the safety and feasibility of hip replacement surgeries in patients with hepatic cirrhosis. <br> METHODS:Thirteen patients with hepatic cirrhosis that underwent hip replacement were retrospectively analyzed to evaluate the treatments and their efficacy before and after replacement. <br> RESULTS AND CONCLUSION:Al 13 surgeries were successful y performed. Al cases were fol owed up for more than five months and were graded according to Child-Pugh Criteria for hepatic functional reserve preoperatively and postoperatively. Five cases of the seven preoperative grade A cases preserved grade A postoperatively during a two-week observation, while another two cases rose to grade B and needed hepatic conservation treatment before discharge. Two cases of the six preoperative grade B cases rose to grade C with developed jaundice and ascites. Of the two, one even suffered a complication of upper gastrointestinal hemorrhage 5 days after surgery. Somatostatin and proton pump inhibitors were administered to stop bleeding. Al cases gained a satisfying recovery. Harris hip score at fol ow-up showed favorable hip function. Hip replacement is safe and feasible for patients with hepatic cirrhosis when ful evaluation of hepatic function and appropriate perioperative management are ensured.