Physiologic Predictors of Postoperative Dialysis After Total Knee Arthroplasty

Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures worldwide as it is highly effective in relieving pain and restoring function in patients with end-stage osteoarthritis and related degenerative joint conditions. However, TKA procedures are not without risk. Although rare, postoperative renal failure requiring dialysis is a serious complication that can lead to increased morbidity, longer hospital stays, higher healthcare costs, and mortality. Even mild postoperative renal dysfunction has been associated with prolonged hospitalization and long-term renal decline.

This study utilized a large, national surgical database to evaluate predictors of postoperative renal failure requiring dialysis in patients undergoing primary TKA. Patient demographics, comorbidities (including chronic kidney disease, diabetes, and congestive heart failure), and operative variables were analyzed. Multivariate regression analysis was conducted to identify independent risk factors for acute renal failure requiring dialysis following surgery.

Preliminary analysis identified several key predictors of postoperative renal failure requiring dialysis, including lower pre-op hematocrit, higher ASA class, higher body mass index, older age, male sex, history of congestive heart failure, hypertension or diabetes, and prolonged operative times. These findings remained significant after adjusting for confounding variables.

Despite being relatively uncommon, postoperative renal failure requiring dialysis in TKA patients is associated with worse clinical outcomes. The identification of specific preoperative risk factors enables better perioperative risk stratification and supports targeted interventions to improve patient safety, particularly in the context of enhanced recovery protocols and outpatient arthroplasty. These results may help inform preoperative counseling, surgical planning, and the development of renal-protective strategies in high-risk orthopedic patients.