Comparison of Postoperative Complications and Survivorship of Total Hip and Knee Arthroplasty in Dialysis and Renal Transplantation Patients

Inoue, Dai; Yazdi, Hamidreza; Goswami, Karan; Tan, Timothy L.; Parvızı, Javad

doi:10.1016/j.arth.2019.10.038

Cited by 25 publications

(60 citation statements)

References 19 publications

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“…One study (23) included both total hip arthroplasties and hemiarthroplasties, and only the former were included in our meta-analysis. Total hip arthroplasties were studied in nine studies (4,9,14,15,(21)(22)(23)(24)26), and total knee arthroplasties were studied in two studies (24,25). Four studies (4,9,21,25) collected data from national databases, while the other six studies (14,15,(22)(23)(24)26) used data from the authors' own institutions with mid-term to longterm follow-up (from 44 to 132 months).…”

Section: Resultsmentioning

confidence: 99%

“…Total hip arthroplasties were studied in nine studies (4,9,14,15,(21)(22)(23)(24)26), and total knee arthroplasties were studied in two studies (24,25). Four studies (4,9,21,25) collected data from national databases, while the other six studies (14,15,(22)(23)(24)26) used data from the authors' own institutions with mid-term to longterm follow-up (from 44 to 132 months). Four studies (21,23,24,26) clearly expressed that only hemodialysis patients were included in the dialysis group, but the other six studies (4, 9, 14, 15, 22, 25) did not provide information on whether peritoneal dialysis or hemodialysis was applied.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies (4,9,21,25) collected data from national databases, while the other six studies (14,15,(22)(23)(24)26) used data from the authors' own institutions with mid-term to longterm follow-up (from 44 to 132 months). Four studies (21,23,24,26) clearly expressed that only hemodialysis patients were included in the dialysis group, but the other six studies (4, 9, 14, 15, 22, 25) did not provide information on whether peritoneal dialysis or hemodialysis was applied. In four studies (14,15,24,26), patients in the renal transplant group had a younger average age compared with the dialysis group.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies (21,23,24,26) clearly expressed that only hemodialysis patients were included in the dialysis group, but the other six studies (4, 9, 14, 15, 22, 25) did not provide information on whether peritoneal dialysis or hemodialysis was applied. In four studies (14,15,24,26), patients in the renal transplant group had a younger average age compared with the dialysis group. Similarly, in another two studies (9, 21), there was a lower percentage of older patients in the renal transplant group.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, in the large-sample-size subgroup, which involved three studies (9,21,24) and 3929 joints, signi cantly lower risk of infection was shown in the renal transplant group (RR =0.19,CI =[0.13, 0.23], P < 0.01, I 2 =0%) (Fig 4).…”

Section: Periprosthetic Joint Infectionmentioning

confidence: 90%

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Total Joint Arthroplasty Has Better Safety and Outcomes in Renal Transplant Patients Than in Dialysis Patients—A Meta-Analysis and Systematic Review

Peng

et al. 2020

Preprint

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Objectives End-stage renal disease (ESRD) patients are at an increased risk of needing total joint arthroplasty (TJA); however, both dialysis and renal transplantation might be potential predictors of adverse TJA outcomes. For dialysis patients, the high risk of blood-borne infection and impaired muscular-skeletal function are threats to the survival of implants, while, for renal transplant patients, immunosuppression therapy is also a concern. There is still no high-level evidence in the published literature that has determined the best timing of TJA for ESRD patients. Methods A literature search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to November 2019) was performed to collect studies that compared TJA outcomes between renal transplant patients and dialysis patients. Literature screening and quality assessments with the Newcastle-Ottawa scale (NOS) were conducted by two reviewers. After the data were extracted, statistical analyses were performed.Results Compared with the dialysis group, a lower risk of mortality (RR=0.56, Cl= [0.42, 0.73], P<0.01, I2=49%) and revision (RR =0.42, CI = [0.30, 0.59], P < 0.01, I2=43%) was detected in the renal transplant group. Different results of periprosthetic joint infection were shown in subgroups with different sample sizes. There was no significant difference in periprosthetic joint infection in the small-sample-size subgroup, while in the large-sample-size subgroup, renal transplant patients had significantly less risk (RR =0.19, CI = [0.13, 0.23], P < 0.01, I2=0%). For dislocation, venous thromboembolic disease, and overall complications, there was no significant difference between the two groups. Conclusion Total joint arthroplasty has better safety and outcomes in renal transplant patients than in dialysis patients. Therefore, delaying total joint arthroplasty in dialysis patients until renal transplantation has been performed would be a desirable option. The controversy among different studies might be partially accounted for that quite a few studies have a qiute small sample size to detect the difference between renal transplant patients and dialysis patients.

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