Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis
Chang-Wan Kim1, Hyun-Jung Kim2, Chang-Rack Lee3
1Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea.
Insights
Patients with chronic kidney disease (CKD) undergoing total joint arthroplasty (TJA) face higher risks of comorbidities and mortality. Dialysis-dependent patients have increased risks for revision and periprosthetic joint infection (PJI), especially after hip surgery.
Area of Science:
- Orthopedic Surgery
- Nephrology
- Public Health
Background:
- Chronic kidney disease (CKD) is associated with increased preoperative comorbidities.
- Evaluating outcomes of total joint arthroplasty (TJA) in CKD patients is crucial.
Purpose of the Study:
- To compare preoperative comorbidities, postoperative mortality, periprosthetic joint infection (PJI), and revision rates after TJA between CKD and non-CKD patients.
- To analyze outcomes based on CKD stage and dialysis dependency.
Main Methods:
- Systematic literature search of MEDLINE, EMBASE, and Cochrane Library.
- Inclusion of studies comparing TJA outcomes between CKD and non-CKD groups, by CKD stage, and evaluating risk factors.
- Comparison of mortality, PJI, and revision rates between CKD/non-CKD and dialysis/non-dialysis groups.
Main Results:
- CKD patients exhibited higher preoperative comorbidities and mortality risk.
- Unadjusted periprosthetic joint infection (PJI) risk was higher in CKD patients, but not significant after adjustment.
- Dialysis patients showed increased mortality, PJI risk (especially after total hip arthroplasty), and revision rates compared to non-dialysis patients.
Conclusions:
- CKD and dialysis dependency significantly increase comorbidity and mortality risks following TJA.
- Dialysis patients face higher revision rates and PJI risks, particularly after total hip arthroplasty.
- Preoperative risk stratification and optimization are essential for CKD patients undergoing TJA.
Background:
This meta-analysis was conducted to evaluate the differences in preoperative comorbidities, postoperative mortality, the rate of periprosthetic joint infection (PJI), and revision rate after total joint arthroplasty (TJA) between patients with chronic kidney disease (CKD)(CKD group) and patients with normal kidney function (non-CKD group).
Methods:
We searched MEDLINE, EMBASE, and the Cochrane Library for studies assessing the effect of CKD on TJA outcome. This meta-analysis included studies that (1) compared the outcomes of TJA between the CKD and non-CKD groups; (2) compared the outcomes of TJA based on CKD stage; and (3) evaluated the risk factors for morbidity or mortality after TJA. We compared the mortality, PJI, and revision rate between CKD and non-CKD groups, and between dialysis-dependent patients (dialysis group) and non-dialysis-dependent patients (non-dialysis group).
Results:
Eighteen studies were included in this meta-analysis. In most studies that assessed preoperative comorbidities, the number and severity of preoperative comorbidities were reported to be higher in the CKD group than in the non-CKD group. The risk of mortality was found to be higher in the CKD and dialysis groups compared with the respective control groups. In the studies based on administrative data, the unadjusted odds ratio (OR) of PJI was significantly higher in the CKD group than in the non-CKD group; however, no significant difference between the groups was noted in the adjusted OR. After total hip arthroplasty (THA), the risk of PJI was higher in the dialysis group than in the non-dialysis group. No significant difference was noted between the groups in the rate of PJI following total knee arthroplasty. The revision rate did not significantly differ between the CKD and non-CKD groups in the studies that were based on administrative data. However, the unadjusted OR was significantly higher in the dialysis group than in the non-dialysis group.
Conclusions:
Preoperative comorbidities and mortality risk were higher in the CKD and dialysis groups than in their respective control groups. The risk of revision was greater in the dialysis group than in the non-dialysis group, and the risk of PJI in the dialysis group became even greater after THA. Surgeons should perform careful preoperative risk stratification and optimization for patients with CKD scheduled to undergo TJA.
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