THE ABNORMALITY OF LIVER FUNCTION IN PATIENTS FOLLOWING ELECTIVE HIP AND KNEE ARTHROPLASTY

Total hip and knee arthroplasty surgery has revolutionised the management of patients with arthritis. The musculoskeletal and cardiopulmonary complications of such surgery are well recognised, however hepatic complications are rare. Elevated liver function tests in the early post operative period were noted in a cohort of patients undergoing elective hip and knee arthroplasty. The aetiology and significance of this phenomenon is uncertain. A prospective study of all patients undergoing elective total hip and knee arthroplasty in one hospital by the senior author over a four year period was undertaken. All patients (over 300) had liver function tests (LFT’s), renal profile and haematological indices recorded pre operatively, one day, one week and six weeks post operatively. A standardised anaesthetic and post operative regime was followed. Significant elevation of the liver enzymes, ALT (from 59 to 120), AST (from 47 to 81) and GGT (from 39 to 50) was noted after one week. These values returned to normal after six weeks. The bilirubin levels were also raised at one day (from four to eight) and at one week (from four to ten). Alkaline phosphatase and globulin levels remained within normal parameters. There was a fall in albumin and total protein levels in the immediate post operative period. In conclusion, many patients undergoing elective total hip and knee arthroplasty experience significant hepatic enzyme dysfunction in the early post operative period. This elevation of liver function tests returns to normal after six weeks. The significance of these findings including likely causes is discussed.