The Impact of Bone Marrow Transplant on Total Joint Arthroplasty Outcomes in Patients Diagnosed with Multiple Myeloma.

Abstract

As screening and treatment for multiple myeloma (MM) improve, 5-year survival rates continue to rise. Bone marrow transplant (BMT) remains a challenging, but effective therapy with lasting benefit. While postoperative outcomes after total joint arthroplasty (TJA) are well-studied in solid organ transplant recipients, data for BMT recipients are limited. This study aimed to define the impact of BMT on 90-day TJA outcomes. We used a large national insurance database to compare post-surgical complications in MM patients who underwent TJA, with or without prior BMT. A retrospective database review assessed differences in demographics, perioperative complications, readmissions, and postoperative risks. Perioperative outcomes were compared using multivariate analysis. The BMT recipients undergo TJA at a younger age (total hip arthroplasty (THA): 61 versus 68 years, total knee arthroplasty (TKA): 66 versus 69 years). The BMT recipients do not have a higher risk of periprosthetic joint infection (THA: P = 0.32; TKA: P = 0.3), periprosthetic fracture (THA: P = 0.9; TKA: P = 0.98), or prosthetic instability (THA: P = 1; TKA: P = 1) within 90 days of TJA. However, BMT recipients have higher rates of pathological fractures (THA: odds ratio (OR): 0.92; TKA: OR: 1.73). All-cause 90-day readmission rates are similar, but BMT recipients have increased odds of thromboembolic events after TJA (THA: OR 2.12, TKA OR: 1.19). Prior BMT does not increase prosthetic complications in MM patients undergoing hip or knee arthroplasty but is associated with higher risks of thromboembolic events and pathological fractures within 90 days of TJA, warranting careful perioperative management.