Knee and hip arthroplasty joint surgical site wound infection in end‐stage renal disease subjects who underwent dialysis or a kidney transplant: A meta‐analysis

Abstract

A meta‐analysis study to assess the knee and hip arthroplasty joint surgical site wound infection (SSWI) in end‐stage renal disease (ESRD) subjects who underwent dialysis or a kidney transplant (KT). A comprehensive literature examination till February 2023 was implemented and 1046 linked studies were appraised. The picked studies contained 5 471 898 subjects with total joint arthroplasty (TJA) at the baseline, 13 049 of them were haemodialysis or renal transplant, and 5 458 849 were control. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of knee and hip arthroplasty SSWI in ESRD subjects who underwent dialysis or a KT by the dichotomous and continuous styles and a fixed or random model. Haemodialysis or renal transplant had a significantly higher postoperative SSWI (OR, 2.13; 95% CI, 1.73–2.62, P < .001) compared with control in TJA subjects. However, no significant difference was observed between haemodialysis and renal transplant in postoperative SSWI (OR, 0.93; 95% CI, 0.16–5.54, P = .94) and between haemodialysis or renal transplant and control in prosthetic joint infection (OR, 1.07; 95% CI, 0.25–4.55, P = .93) in TJA subjects. Haemodialysis had a significantly higher prosthetic joint infection (OR, 1.92; 95% CI, 1.21–3.03, P = .005) compared with renal transplant in TJA subjects. Haemodialysis or renal transplant had a significantly higher postoperative SSWI in TJA subjects. Also, haemodialysis had a significantly higher prosthetic joint infection compared with renal transplant in TJA subjects. Although precautions should be taken when commerce with the consequences because a low number of selected studies was picked for certain comparisons in this meta‐analysis.

Editorial Comment on the Article by A.N. Tsed et al. “Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?”

“…С другой стороны, если пациент с ХПН, находящийся не гемодиализе, обратился на менее выраженной стадии разрушения сустава, например, когда очаг остеонекроза локализован только в медиальном мыщелке бедренной кости, деформация еще не носит фиксированный характер и контрактура выражена умеренно, то вполне успешно вместо тотальной может быть выполнена частичная артропластика. Авторы продемонстрировали, что частота перипротезной инфекции у больных, находящихся на гемодиализе, в 6,5 раз выше по сравнению с контрольной группой, что существенно превышает показатели, полученные в других актуальных исследованиях [8]. В данной ситуации одномыщелковое эндопротезирование вполне логично может быть методом выбора по сравнению с тотальным, так как ассоциировано с меньшей на два порядка частотой инфекционных осложнений [9].…”