Inferior outcome of rotator cuff repair in chronic hemodialytic patients

Abstract

Background Repair of rotator cuff tears has yielded excellent functional outcomes in recent decades; however, poor outcomes and dissatisfaction have been noted in specific groups. Spontaneous tendon rupture has been reported in patients receiving long-term hemodialysis owing to alteration of tendon structure, which might impede functional recovery after rotator cuff repair. The purpose of the present study was to compare the clinical outcomes between hemodialysis and non-hemodialysis patients after rotator cuff repair. Methods We retrospectively reviewed patients who underwent mini-open rotator cuff repair from Jan 2013 to Jan 2017. A total of 14 patients under chronic hemodialysis (HD) were matched to non-hemodialysis (NHD) patients at a 1:2 ratio according to age, gender, tear size, severity of fatty infiltration and history of diabetes. Pre- and post-operative functional outcome was assessed using the simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES), Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and visual analog scale (VAS) scores. Clinical functional outcome at the last follow-up was adopted for comparison of the HD and NHD groups. Results A total of 42 patients were enrolled in this comparative study, with a mean age of 66.64 ± 1.68 years in the HD group and 65.71 ± 5.40 years in the NHD group. At the final clinical assessment, the post-operative functional outcome was significantly improved in both groups ( p < 0.001). However, the functional outcome of the HD group was significantly inferior to that of the NHD group in terms of the SST score (6.50 ± 2.24 vs 9.39 ± 1.87, p < 0.001), ASES score (63.17 ± 15.93 vs 86.96 ± 11.43, p < 0.001), UCLA score (20.14 ± 7.71 vs 29.82 ± 5.08, p < 0.001) and VAS score (3.00 ± 0.96 vs 1.21 ± 1.03, p < 0.001). Conclusion The improvement of pain and functional improvement of long-term hemodialysis patients were inferior to those of patients without hemodialysis after mini-open rotator cuff repair.

A Systematic Review of Handgrip Strength Measurement in Clinical and Epidemiological Studies of Kidney Disease: Toward a Standardized Approach

“…Conversely, other studies have reported no differences when shoulder joints varied between 90° and 180° [78] or 0 and 180° shoulder flexion [81]. Given the complex nature of shoulder movement and risk of injury in a population characterized by deconditioning and poor mobility [82], we suggest HGS should safely be performed with the elbow in 90° flexion and the shoulder adducted (0°).…”

Increased Risk of Perioperative Complications in Dialysis Patients Following Rotator Cuff Repairs and Knee Arthroscopy

“…Although several previous studies have investigated dialysis versus non-dialysis patients undergoing various orthopaedic procedures, this study analyzed complication rates in the dialysis population undergoing RCR or knee arthroscopies. 9 , 10 , 11 , 20 , 21 , 30 , 31 , 32 , 33 In this study, the experimental group consisting of dialysis patients undergoing both RCR and KA were compared to a matched control group of non-dialysis patients matched for key demographic factors and comorbidities. There were no significant differences in age, sex, BMI, smoking status, functional status, or ASA classification between experimental and control groups, further ensuring that differences in outcomes between groups are due to the independent effect of dialysis.…”

“…A recent study investigated RCR in dialysis patients compared to non-dialysis patients using institutional data from 42 patients. 9 Unlike our study, this study focused solely on functional outcomes and did not include postoperative complications or length-of-stay data. The study found that dialysis patients experienced significantly worse functional outcomes at a mean follow-up of 21 months when assessed using SST, ASES, UCLA, and visual analog scale shoulder scores.…”

“…8 Additionally, a retrospective study by Wu et al demonstrated that the systemic effects in hemodialysis-dependent patients yielded inferior results in shoulder function and pain following RCR compared to patients without hemodialysis. 9 Although a life-preserving treatment, hemodialysis has numerous side effects with prior studies showing increased adverse events, readmissions, and reoperation and mortality rates. 10,11 Chronic hemodialysis is a known significant risk factor for weakening tendon structures, 12 attributed to elevated serum levels of b2 microglobulin (b2M) that can no longer be filtered by failing kidneys.…”

“…demonstrated that the systemic effects in hemodialysis-dependent patients yielded inferior results in shoulder function and pain following RCR compared to patients without hemodialysis. 9 …”