Mid-term clinical outcomes and complications of primary total knee arthroplasty in hemodialysis patients: a retrospective comparative cohort study

Abstract

Background Numerous patients who receive hemodialysis (HD) undergo total knee arthroplasty (TKA) due to advanced knee joint arthritis. However, there are few studies that describe the clinical outcomes and complications of TKA in HD patients. This study investigated the mid-term results of TKA in patients undergoing HD. Methods This single-center retrospective study compared clinical and surgical outcomes following TKA in patients who were receiving HD with those who were not. We used propensity scores to match 21 knees of 18 patients who received HD to 706 knees of 569 patients who had not received HD, from a total of 727 knees (587 patients) that underwent primary unilateral TKA. The clinical outcomes were evaluated using the American Knee Society Score-knee (AKSS-knee) and AKSS-function scores. The primary surgical outcome measure was the number of knees with postoperative complications. Results In both the HD and non-HD groups, postoperative AKSS-knee and function scores significantly improved when compared to preoperative values. Postoperative AKSS-knee and function scores were not significantly different between the groups. The number of knees with postoperative complications was larger in the HD group than the non-HD group within the first postoperative month, 0–12 months, 12–24 months, 0–24 months, and two years after surgery. Additionally, in the HD group, more complications occurred in the first month than any subsequent month in the two years after surgery. Conclusions TKA improves AKSS-knee and function scores equivalently for HD patients and non-HD patients. However, HD patients develop more complications after TKA, especially within the first month. Therefore, surgeons who perform TKA for HD patients should obtain informed consent after explaining the possible complications, and HD patients should be carefully observed following TKA.

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

“…From a total of 1046 linked investigation that was inspected, 16 articles published between 2010 and 2023 fit the inclusion criteria and were selected and involved in the study 2,4,5,12‐24 . Table 2 offers the verdicts from these studies.…”

“…From a total of 1046 linked investigation that was inspected, 16 articles published between 2010 and 2023 fit the inclusion criteria and were selected and involved in the study. 2 , 4 , 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 Table 2 offers the verdicts from these studies. The 5 471 898 subjects with TJA were in the picked studies' baseline; 13 049 of them were haemodialysis or renal transplant, and 5 458 849 were controls.…”

“…In the studies nominated for the meta-analysis, 5 471 898 subjects with TJA were in the picked studies' baseline, 13 049 of them were haemodialysis or renal transplant, and 5 458 849 were control. 2,4,5,[12][13][14][15][16][17][18][19][20][21][22][23][24] Haemodialysis or renal transplant had a significantly higher postoperative surgical site wound infection (SSWI) however no significant difference was found in PJI compared with control in TJA subjects. Haemodialysis had a significantly higher PJI, however, no significant difference was observed in postoperative SSWI compared with renal transplant in TJA subjects.…”

“…In the studies nominated for the meta‐analysis, 5 471 898 subjects with TJA were in the picked studies' baseline, 13 049 of them were haemodialysis or renal transplant, and 5 458 849 were control 2,4,5,12‐24 . Haemodialysis or renal transplant had a significantly higher postoperative surgical site wound infection (SSWI) however no significant difference was found in PJI compared with control in TJA subjects.…”

Total knee arthroplasty in dialysis patients: a national in-patient sample-based study of perioperative complications

“…In 2018 alone, approximately 780,000 Americans had renal failure requiring dialysis or a kidney transplant for survival [ 2 ]. More than 70% of chronic kidney failure patients receive dialysis; however, these patients are prone to advanced osteoarthritis and osteonecrosis of the knee, which often necessitates total knee arthroplasty [ 3 ].…”