Hip hemiarthroplasty for femoral neck fractures in end-stage renal disease patients on dialysis compared to patients with late-stage chronic kidney disease

Ding, Benjamin Tze Keong; Shinde, Abhishek; Tan, Kelvin Guoping

doi:10.11622/smedj.2019090

Cited by 12 publications

(21 citation statements)

References 36 publications

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“…However, such relationships were not observed in the ACDF group. Although recent evidence reported a risk of loosening of the prosthesis in patients with hip fracture and sec-ondary hyperparathyroidism due to ESRD, we also did not observe a correlation between the iPTH level and the incidence of implant loosening in either group [23]. Surprisingly, a lower iPTH level was associated with the incidence of ASD in the ACDF group.…”

Section: Discussioncontrasting

confidence: 99%

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

Shih

Tseng

et al. 2021

JCM

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Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody fusion surgery. This study included 62-consecutive patients with ESRD who underwent anterior cervical discectomy and fusion (ACDF) or transforaminal lumbar interbody fusion (TLIF) surgery for symptomatic spinal disorder. The most recent preoperative serum calcium, phosphate, and iPTH levels were recorded, and the postoperative radiographic outcomes were assessed. A significant correlation was found between the occurrence of cage subsidence and higher blood phosphate, calcium–phosphate product (Ca × P), and iPTH levels in the TLIF group. The occurrence of pedicle screw loosening was related to higher blood phosphate and Ca × P product in the TLIF group. However, no correlation was found between the fusion grades and the serum levels in either the TLIF or ACDF groups. These results indicated that higher preoperative serum phosphate and Ca × P product are risk factors for both cage subsidence and screw loosening in patients with ESRD who underwent TLIF surgery. Higher iPTH levels are also a possible risk factor for cage subsidence.

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Section: Discussioncontrasting

confidence: 99%

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

Shih

Tseng

et al. 2021

JCM

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“…CKD-MBD and delayed ability of wound healing may worsen post-operative outcomes for patients living with CKD [ 5 , 37 ]. Recent evidence reported associations between post-hemiarthroplasty mortality risk and baseline renal function [ 38 , 39 ]. In a case–control study of 59 patients receiving hemiarthroplasty following hip fracture, ESRD patients were more likely to develop cardiopulmonary complications and hyperparathyroidism post-operatively compared to the non-ESRD group [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence reported associations between post-hemiarthroplasty mortality risk and baseline renal function [ 38 , 39 ]. In a case–control study of 59 patients receiving hemiarthroplasty following hip fracture, ESRD patients were more likely to develop cardiopulmonary complications and hyperparathyroidism post-operatively compared to the non-ESRD group [ 39 ]. Moreover, a greater mortality risk was observed over the study follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Prognostic performance of clinical assessment tools following hip fracture in patients with chronic kidney disease

Mierlo

McLauchlan

et al. 2021

Int Urol Nephrol

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Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD. Methods Patients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD. Results 397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex, intracapsular fracture and more severe CKD, co-morbidity and frailty status were all associated with an increased mortality risk. Patients with dialysis-dependent CKD and severe/very severe frailty had a hazard ratio for mortality of 2.55 (95% Cl 2.11–2.98) and 3.11 (95% Cl 2.47–3.93), respectively. The Clinical Frailty Scale demonstrated the best prognostic accuracy for both 30 day [Area Under the Curve (AUC) 0.91, 95% Cl 0.84–0.97] and 1 year mortality (AUC 0.93, 95% Cl 0.87–1.00). Conclusion Patients with advanced CKD and severe frailty have a high mortality risk following hip fracture. The Clinical Frailty Scale is an excellent prognostic tool for mortality in this setting and could be easily incorporated into routine clinical practice.

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“…We advocate using cemented replacement arthroplasty in this group of patients for immediate stability. There is a documented risk of loosening of the prosthesis in patients with secondary hyperparathyroidism due to ESRD and hence the need to treat it as an osteoporotic fracture in the elderly with the need for cementing as a precaution [12]. These patients who undergo replacement arthroplasty will be able to weight-bear immediately postoperatively.…”

Section: Figure 4: Pelvic Plain Radiographs Of the Patient In Case 3 Show Nonunion Of Right Neck Of Femur (Nof) Fracture And Non-displacementioning

confidence: 99%

Neck of Femur Fracture in Young Patients With End-Stage Renal Disease and Hyperparathyroidism: A Report of Three Cases and Proposed Treatment Algorithm

Raj¹,

Kow²,

Ramalingam³

et al. 2021

Cureus

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Secondary hyperparathyroidism is a complication arising from untreated end-stage renal disease (ESRD). It can invariably lead to osteoporosis and subsequently cause pathological neck of femur (NOF) fracture. Despite being young, osteosynthesis in neck of femur fractures of these patients often leads to nonunion and implant failure due to severely osteoporotic bone. We present our experience in managing three young patients with ESRD and secondary hyperthyroidism who sustained NOF fractures. All three patients were successfully treated and showed no complication at one year post-operation. Based on our experience and literature review, we propose a simple algorithm to guide the management of these patients.

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Hip hemiarthroplasty for femoral neck fractures in end-stage renal disease patients on dialysis compared to patients with late-stage chronic kidney disease

Cited by 12 publications

References 36 publications

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

Prognostic performance of clinical assessment tools following hip fracture in patients with chronic kidney disease

Neck of Femur Fracture in Young Patients With End-Stage Renal Disease and Hyperparathyroidism: A Report of Three Cases and Proposed Treatment Algorithm

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