Increased Risk of Complications and Mortality After Total Joint Arthroplasty in Dialysis-Dependent Patients

Patients with chronic kidney disease (CKD) and dialysis dependence represent high-risk populations with increased demand for total joint arthroplasty (TJA). We aimed to assess surgical outcomes of CKD and dialysis-dependent (DD) patients undergoing TJA.

A multicenter retrospective review of TJA records between June 2011 and July 2022 was conducted. Patients with a diagnosis of CKD who were DD at the time of surgery were propensity-matched to non-DD CKD patients and control subjects without CKD in a ratio of 1:5:5. Matched comparisons and Kaplan-Meier survival analyses were conducted for a total of 176 (DD: 16) total knee arthroplasty (TKA) and 297 (DD: 27) total hip arthroplasty (THA) patients.

Medical complications within 90 days after both TKA (control: n = 1, 1.3%; CKD: n = 3, 3.8%; DD: n = 3, 18.8%; P = 0.005) and THA (control: n = 4, 3%; CKD: n = 4, 3%; DD: n = 6, 22.2%; P < 0.001) were significantly higher in the DD group. Infection and revision rates at last follow-up were similar between the three groups after TKA (P > 0.05) and THA (P > 0.05). In Kaplan-Meier analyses, survivorship free of mortality was lowest in the DD group after THA at 40.3% compared with 100% in the control and 78.8% in the CKD groups (P < 0.001).

Dialysis-dependent patients are at an increased risk of postoperative medical complications and mortality compared with matched groups with and without CKD. Infection and revision rates seem to be similar. We advocate for a shared decision-making approach between patient and surgeon to include a thorough discussion weighing postoperative complication risk, patient function, and life expectancy.

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