BACKGROUND: Dialysis-dependent patients can develop osteoarthritis or osteonecrosis, warranting hip or knee arthroplasty. Their comorbidities predispose them to complications. Our goal was to determine inpatient outcomes of dialysis-dependent patients after primary elective total hip or knee arthroplasty. METHODS: In the National Inpatient Sample, we identified 2934 dialysis-dependent patients who had undergone total hip or knee arthroplasty from 2000 through 2009 and compared them with 6,186,475 patients who had undergone the same procedures and were not dialysis-dependent. We described demographic characteristics, comorbidities, and outcomes and assessed associations of dialysis status with inpatient mortality and complications. RESULTS: In the hip arthroplasty group, dialysis-dependent patients were younger (63.2 compared with 65.2 years; p = 0.0476) and more commonly diagnosed with osteonecrosis (34.29% compared with 10.94%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (1.88% compared with 0.13%; p < 0.0001) and greater overall complication rates (9.98% compared with 4.97%; p = 0.0001). Dialysis was an independent risk factor for mortality (odds ratio, 6.66; 95% confidence interval [95% CI], 2.66 to 16.66) and complications (odds ratio, 1.53; 95% CI, 1.01 to 2.33). In the knee arthroplasty group, dialysis-dependent patients were similar in age (66.7 compared with 66.8 years; p = 0.8085) and were more commonly diagnosed with osteonecrosis (3.32% compared with 0.74%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (0.92% compared with 0.10%; p < 0.0001) and greater overall complication rates (12.48% compared with 5.00%; p < 0.0001). Dialysis status was an independent risk factor for mortality (odds ratio, 3.31; 95% CI, 1.04 to 10.54) and complications (odds ratio, 1.86; 95% CI, 1.34 to 2.60). CONCLUSIONS: Total hip and knee arthroplasty in dialysis-dependent patients presents high risk, with inpatient mortality rates ten to twenty times greater and overall complication rates two times greater than in non-dialysis-dependent patients. Arthroplasty should be approached with caution and preferably should be delayed until after renal transplantation.
BACKGROUND: Dialysis-dependent patients can develop osteoarthritis or osteonecrosis, warranting hip or knee arthroplasty. Their comorbidities predispose them to complications. Our goal was to determine inpatient outcomes of dialysis-dependent patients after primary elective total hip or knee arthroplasty. METHODS: In the National Inpatient Sample, we identified 2934 dialysis-dependent patients who had undergone total hip or knee arthroplasty from 2000 through 2009 and compared them with 6,186,475 patients who had undergone the same procedures and were not dialysis-dependent. We described demographic characteristics, comorbidities, and outcomes and assessed associations of dialysis status with inpatient mortality and complications. RESULTS: In the hip arthroplasty group, dialysis-dependent patients were younger (63.2 compared with 65.2 years; p = 0.0476) and more commonly diagnosed with osteonecrosis (34.29% compared with 10.94%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (1.88% compared with 0.13%; p < 0.0001) and greater overall complication rates (9.98% compared with 4.97%; p = 0.0001). Dialysis was an independent risk factor for mortality (odds ratio, 6.66; 95% confidence interval [95% CI], 2.66 to 16.66) and complications (odds ratio, 1.53; 95% CI, 1.01 to 2.33). In the knee arthroplasty group, dialysis-dependent patients were similar in age (66.7 compared with 66.8 years; p = 0.8085) and were more commonly diagnosed with osteonecrosis (3.32% compared with 0.74%; p < 0.0001) than non-dialysis-dependent patients. Dialysis-dependent patients had higher inpatient mortality rates (0.92% compared with 0.10%; p < 0.0001) and greater overall complication rates (12.48% compared with 5.00%; p < 0.0001). Dialysis status was an independent risk factor for mortality (odds ratio, 3.31; 95% CI, 1.04 to 10.54) and complications (odds ratio, 1.86; 95% CI, 1.34 to 2.60). CONCLUSIONS: Total hip and knee arthroplasty in dialysis-dependent patients presents high risk, with inpatient mortality rates ten to twenty times greater and overall complication rates two times greater than in non-dialysis-dependent patients. Arthroplasty should be approached with caution and preferably should be delayed until after renal transplantation.
Authors: Daniel D Bohl; Nathaniel T Ondeck; Bryce A Basques; Brett R Levine; Jonathan N Grauer Journal: Clin Orthop Relat Res Date: 2017-12 Impact factor: 4.176
Authors: Karim G Sabeh; Samuel Rosas; Leonard T Buller; Andrew A Freiberg; Cynthia L Emory; Martin W Roche Journal: J Knee Surg Date: 2018-05-23 Impact factor: 2.501
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Authors: LaTonya J Hickson; Wigdan H Farah; Rebecca L Johnson; Bjorg Thorsteinsdottir; Daniel S Ubl; Brandon J Yuan; Robert Albright; Andrew D Rule; Elizabeth B Habermann Journal: Kidney Int Rep Date: 2018-07-07