Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

Abstract

Background: This meta-analysis was conducted to evaluate the differences in preoperative comorbidities, postoperative mortality, the rate of periprosthetic joint infection (PJI), and revision rate after total joint arthroplasty (TJA) between patients with chronic kidney disease (CKD)(CKD group) and patients with normal kidney function (non-CKD group). Methods: We searched MEDLINE, EMBASE, and the Cochrane Library for studies assessing the effect of CKD on TJA outcome. This meta-analysis included studies that (1) compared the outcomes of TJA between the CKD and non-CKD groups; (2) compared the outcomes of TJA based on CKD stage; and (3) evaluated the risk factors for morbidity or mortality after TJA. We compared the mortality, PJI, and revision rate between CKD and non-CKD groups, and between dialysis-dependent patients (dialysis group) and non-dialysis-dependent patients (non-dialysis group). Results: Eighteen studies were included in this meta-analysis. In most studies that assessed preoperative comorbidities, the number and severity of preoperative comorbidities were reported to be higher in the CKD group than in the non-CKD group. The risk of mortality was found to be higher in the CKD and dialysis groups compared with the respective control groups. In the studies based on administrative data, the unadjusted odds ratio (OR) of PJI was significantly higher in the CKD group than in the non-CKD group; however, no significant difference between the groups was noted in the adjusted OR. After total hip arthroplasty (THA), the risk of PJI was higher in the dialysis group than in the non-dialysis group. No significant difference was noted between the groups in the rate of PJI following total knee arthroplasty. The revision rate did not significantly differ between the CKD and non-CKD groups in the studies that were based on administrative data. However, the unadjusted OR was significantly higher in the dialysis group than in the non-dialysis group. Conclusions: Preoperative comorbidities and mortality risk were higher in the CKD and dialysis groups than in their respective control groups. The risk of revision was greater in the dialysis group than in the non-dialysis group, and the risk of PJI in the dialysis group became even greater after THA. Surgeons should perform careful preoperative risk stratification and optimization for patients with CKD scheduled to undergo TJA.

Incidence and risk factors analysis for mortality after total knee arthroplasty based on a large national database in Korea

“…The effect of renal disease on mortality in patients who underwent TKA has been investigated in several studies 20 , 23 , 28 – 33 . In the meta-analysis of mortality, the hazard ratio of mortality after TKA was significantly higher in patients with chronic kidney disease (HR = 1.45; 95% CI = 1.02–2.05, P = 0.04) 31 . Hunt et al reported that renal disease increased the risk of 45-day mortality after TKA in a study involving a large national registry (HR = 2.18; 95% CI = 1.76 to 2.69, P < 0.0005) 23 .…”

“…The decrease in renal perfusion due to perioperative blood loss is expected to adversely affect the progression of renal disease and could increase the risk of mortality. Renal disease could also affect the risk of complications such as peri-prosthetic joint infection and rate of arthroplasty revision surgery 31 , 33 . Therefore, careful preoperative risk stratification is important in patients with renal disease.…”

Prevention of early complications following total hip replacement

“…The optimal interim period for performing a THA after septic arthritis is debatable, and no consensus has been reached [54]. A recent multicentre study employing a receiver operating characteristic (ROC) analysis indicated that [45] Serum creatinine >1.5 mg/dL; Creatinine clearance rate < 100 mL/min Anaemia (Hb < 9 g/dL) [46] Smoking Recent history of intra-articular injection [47] Inflammatory arthritis [48], Previous septic arthropathy [49] Systemic infectious process [50] 5.9 months after the initial treatment might represent a suitable timepoint. However, when the population was dichotomised by this threshold, the authors reported no difference with respect to the PJI rate [55].…”

Comparison of Total Knee Arthroplasty Outcomes Between Renal Transplant and End Stage Renal Disease Patients

“…Several risk factors have been associated with an increased risk of PJI, including obesity, liver disease, diabetes, and renal disease. 6 , 7 The relationship between renal disease and PJI is not fully understood, but it has been hypothesized that electrolyte imbalances 8 and the blunting of the immune system caused by uremia and systemic inflammation are possible mechanisms. 9 - 11 Moreover, as the condition progresses to renal failure, the two treatment options available, dialysis and renal transplant (RT), both further increase PJI risk.…”

“…This is particularly problematic because both treatments have been associated with amyloid deposition, osteonecrosis, renal osteodystrophy, and osteoarthritis, all of which increase the need for TJA. 6,[12][13][14][15] Thus, a deeper understanding of the interplay between ESRD, RT, and TJA outcomes is necessary to better care for patients who simultaneously have a greater need for TJA and a greater risk for adverse complications after TJA.…”