Impact of chronic kidney disease on outcomes after total joint arthroplasty: a meta-analysis and systematic review

Abstract

Background Comorbidities in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) may compromise outcomes with increased hospital stays, readmission and mortality rates. We aimed to determine whether chronic kidney disease (CKD) affects postoperative outcomes of patients undergoing total joint arthroplasty (TJA).Methods To identify studies for this review and meta-analysis, two independent reviewers searched PubMed, Cochrane, EMBASE and Google Scholar until April 1, 2019, and identi ed additional studies by manual search of reference lists. Prospective or retrospective studies with quantitative outcomes for patients undergoing TJA were selected. Outcomes were compared between patients with underlying CKD stage >=3 or eGFR< 60 mL/min/1.73 m2 versus mild/non-CKD as controls. Main endpoints were mortality, re-operation and re-admission rates.Results Among 59 studies reviewed, 19 meeting the eligibility criteria were included, providing data of 2,141,393 patients. After THA or TKA, CKD was associated with higher mortality risk than non-CKD (pooled OR 2.20, 95%CI = 1.90 to 2.54; P < 0.001); no signi cant differences were seen in re-operation between CKD and non-CKD patients (pooled OR 1.26, 95%CI = 0.84 to 1.88; P=0.266); and CKD patients had higher any-cause re-admission rates (pooled OR= 1.57, 95%CI = 1.27 to 1.94, P<0.001). ConclusionUnderlying CKD predicts adverse outcomes after elective TJA with increased risk of mortality, re-admission, surgical site infection, and perioperative transfusion. Findings of this review and meta-analysis highlight CKD as a critical contributor to complications after TJA and may be helpful to surgeons when advising patients about associated risks of TJA.

RETRACTED: The impact of chronic kidney disease and dialysis therapy on outcomes of elderly patients with hip fractures: A systematic review and meta-analysis

“…13–15 The resulting detrimental effect on the musculoskeletal system further predisposes patients with poor renal functioning towards fractures, 16,17 and worsens their prognostic outcomes in the post-operative phase of reconstructive surgery. 18…”

“…anemia, diabetes), and the resulting effect on the musculoskeletal system is associated with markedly higher rates of complications during post-operative recovery after a hip reconstruction surgery. 18,26–29…”

“…[13][14][15] The resulting detrimental effect on the musculoskeletal system further predisposes patients with poor renal functioning towards fractures, 16,17 and worsens their prognostic outcomes in the post-operative phase of reconstructive surgery. 18 In the last decade numerous reports has conclusively demonstrated that the rate of fractures especially in the hip is rapidly increasing in severe chronic kidney disease patients, [19][20][21] leading to widespread short-and long-term detrimental effects on morbidity and mortality related outcomes in patients undergoing hemodialysis. [22][23][24] Recent advances in the modern surgical interventions has successfully reduced morbidity-and mortality-related outcomes associated with hip fractures in healthy populations groups.…”

Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis

“…Several risk factors affect the outcome of TJA, and ESRD has been associated with increased complications following TJA. 28 In comparison with patients who have normal renal function, ESRD has been shown to increase the risk of mortality, re-admission, surgical site infection, and perioperative transfusion. 28 In patients under dialysis or who have received a KT, other complications such as haematogenous spreading of bacteria, catheter-related infections and opportunistic infections may occur.…”

“… 28 In comparison with patients who have normal renal function, ESRD has been shown to increase the risk of mortality, re-admission, surgical site infection, and perioperative transfusion. 28 In patients under dialysis or who have received a KT, other complications such as haematogenous spreading of bacteria, catheter-related infections and opportunistic infections may occur. 2 , 21 In a comprehensive review performed by Browne et al, the authors noted that dialysis-dependent patients have an increased risk for infection and bacteremia following THA and TKA.…”