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

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.