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Lower stages of chronic kidney disease (CKD) do not affect outcomes after total hip or knee arthroplasty


Sunday, November 3, 2013

Brian Deegan, Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
Raveesh D. Richard, MD, Department of Orthopaedics, Geisinger Medical Center, Danville, PA
Thomas R. Bowen, MD, Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
Jove Graham, PhD, Weis Center for Health Research, Geisinger Medical Center, Danville, PA
Robert Perkins, M.D., Department of Nephrology, Bassett Medical Center, Cooperstown, NY
Michael Foltzer, M.D., Department of Infectious Diseases, Geisinger Medical Center, Danville, PA
Introduction Dialysis and kidney transplantation adversely impact the outcome of total joint arthroplasty. Complication rates, including infection, revision, and death, have not been reported for patients with earlier stages of CKD. In an aging population with a high prevalence of CKD, there is insufficient data to inform the discussion regarding anticipated outcomes of joint replacement for these patients. The purpose of this study is to evaluate post-operative complications in patients with stage 1-2 and 3 CKD who undergo elective hip (THA) and knee arthroplasty (TKA).

Methods The outcomes of 779 patients who underwent THA or TKA between 2004 and 2011 (median 2.65 years follow-up) with evidence of CKD at surgery were retrospectively reviewed via an electronic medical record. Stages of CKD were categorized by the presence of proteinuria and two glomerular filtration rates separated by at least six months. Survival analysis was used to compare all-cause mortality, revision and infection among groups.

Results We compared 377 stage 1-2 CKD and 402 stage 3 CKD patients and observed no significant differences between the stages in terms of 90-day readmissions or revisions (p=0.67,0.38). Infections were marginally lower in stage 3 (p=0.05). For patients with stage 3 CKD, mortality rate after THA (16%) and overall mortality (9%) were significantly higher than mortality rate after THA (5%) and overall mortality (4%) in patients with stages 1-2 CKD (p=0.02).

Conclusion There is no increased risk of joint infection or revision in patients with stages 3 versus stage 1-2 CKD who undergo elective THA and TKA.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public

Learning Objectives:
Assess the risk of post-operative complications in patients with stages 1-3 chronic kidney disease who undergo elective hip or knee arthroplasty.

Keyword(s): Chronic Diseases, Risk Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary author on this retrospective review.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.