Can total knee arthroplasty be safely performed in patients with chronic renal disease?

Abstract

Background and purposeThe prevalence of chronic renal disease (CRD) is rising worldwide. Patients with CRD are more likely to have associated medical problems and are at greater risk of postoperative morbidity and mortality. We evaluated patient characteristics and risk of early revision, surgical site infection (SSI), thromboembolic events, mortality, and re-admission of patients with CRD undergoing total knee arthroplasty (TKA). We hypothesized that this patient population would have higher rates of complications.Patients and methodsWe conducted a retrospective analysis of data that had been prospectively collected by a Total Joint Replacement Registry. All primary TKAs performed from 2005 through 2010 were included. 41,852 primary TKA cases were evaluated, of which 2,686 (6.4%) TKA procedures had been performed in CRD patients. Patient characteristics, comorbidities, and general health status were evaluated. Cox proportional hazard regressions and logistic regressions were used to evaluate the association of CRD with outcomes while adjusting for confounding variables.ResultsThe mean age of the CRD cohort was 67 years and approximately two-thirds of the patients were female. The median follow-up time was 2.1 years. Compared to TKA patients without CRD the CRD patients were older, had poorer general health, and had a higher prevalence of comorbidities. They had a higher incidence of deep SSI (0.9% vs. 0.7%), superficial SSI (0.5% vs. 0.3%), deep vein thrombosis (0.6% vs. 0.4%), any-time mortality (4.7% vs. 2.4%), 90-day mortality (0.4% vs. 0.2%), and 90-day re-admission (10% vs. 6.0%) than patients without CRD. However, after adjustment for confounding variables, CRD patients were at 1.9 times (95% CI: 1.1–3.5) increased risk of superficial SSI, 1.3 times (CI: 1.1–1.6) increased risk of re-admission within 90 days, and 1.5 times (CI: 1.2–1.8) increased risk of mortality at any point after the procedure. The risks of all other complications were not statistically significantly different in patients with CRD compared to patients without CRD.ConclusionsCRD patients undergoing TKA have more comorbidities and a higher risk for superficial SSI, 90-day re-admission, and any-time mortality.

Total Joint Arthroplasty in Patients with Chronic Renal Disease: Is It Worth the Risk?

“…Recent studies have shown the prevalence of chronic kidney disease in an elective arthroplasty setting to be between 6% and 27% of patients [5,9,18]. Bozic et al [7,19] have previously shown that renal disease is an independent risk factor for early revision after primary hip and knee arthroplasty, as well as periprosthetic joint infection.…”

“…In a comparatively small cohort of 526 patients, Ackland et al [5] found that patients with CKD had increased pulmonary, infectious, and cardiovascular complications while experiencing an increased length of stay of 4 days. Miric et al [9,18] found an increased risk for 90-day readmission for both THA and TKA patients in the setting of CRD. Pugely et al [10] corroborated these findings, showing that dialysis, high serum BUN, and elevated serum creatinine were predictive risk factors for 30-day readmission.…”

Not all total joint replacement patients are created equal: preoperative factors and length of stay in hospital

“…Chronic kidney disease is common in adults older than 65 years, who are the fastest growing subset of patients with end-stage renal disease. 23 While studies have shown that THA and TKA can be performed safely in this patient cohort, 24,25 close attention must be paid to mitigate the perioperative risks associated with chronic renal disease.…”

Perioperative Implications of End-stage Renal Disease in Orthopaedic Surgery

“…In a retrospective review of 142 patients with CKD (stages 3 through 5) undergoing elective primary and revision THA and total knee arthroplasty (TKA), Ackland et al 24 reported a twofold risk of pulmonary, infectious, cardiovascular, gastrointestinal, wound, renal, neurologic, and pain complications compared with that of normal patients. 27 In contrast, retrospective cohort studies have shown that arthroplasty may be well tolerated, with mortality and complication rates that are comparable to those in the general population. Smaller and more dated retrospective studies have demonstrated complication rates of up to 100%.…”