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. 2020 Feb 12;32(1):12.
doi: 10.1186/s43019-020-0029-8.

Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

Chang-Wan Kim  1 , Hyun-Jung Kim  2 , Chang-Rack Lee  3 , Lih Wang  4 , Seung Joon Rhee  5
Affiliations

Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

Chang-Wan Kim et al. Knee Surg Relat Res. .

Abstract

Background: This meta-analysis was conducted to evaluate the differences in preoperative comorbidities, postoperative mortality, the rate of periprosthetic joint infection (PJI), and revision rate after total joint arthroplasty (TJA) between patients with chronic kidney disease (CKD)(CKD group) and patients with normal kidney function (non-CKD group).

Methods: We searched MEDLINE, EMBASE, and the Cochrane Library for studies assessing the effect of CKD on TJA outcome. This meta-analysis included studies that (1) compared the outcomes of TJA between the CKD and non-CKD groups; (2) compared the outcomes of TJA based on CKD stage; and (3) evaluated the risk factors for morbidity or mortality after TJA. We compared the mortality, PJI, and revision rate between CKD and non-CKD groups, and between dialysis-dependent patients (dialysis group) and non-dialysis-dependent patients (non-dialysis group).

Results: Eighteen studies were included in this meta-analysis. In most studies that assessed preoperative comorbidities, the number and severity of preoperative comorbidities were reported to be higher in the CKD group than in the non-CKD group. The risk of mortality was found to be higher in the CKD and dialysis groups compared with the respective control groups. In the studies based on administrative data, the unadjusted odds ratio (OR) of PJI was significantly higher in the CKD group than in the non-CKD group; however, no significant difference between the groups was noted in the adjusted OR. After total hip arthroplasty (THA), the risk of PJI was higher in the dialysis group than in the non-dialysis group. No significant difference was noted between the groups in the rate of PJI following total knee arthroplasty. The revision rate did not significantly differ between the CKD and non-CKD groups in the studies that were based on administrative data. However, the unadjusted OR was significantly higher in the dialysis group than in the non-dialysis group.

Conclusions: Preoperative comorbidities and mortality risk were higher in the CKD and dialysis groups than in their respective control groups. The risk of revision was greater in the dialysis group than in the non-dialysis group, and the risk of PJI in the dialysis group became even greater after THA. Surgeons should perform careful preoperative risk stratification and optimization for patients with CKD scheduled to undergo TJA.

Keywords: Arthroplasty; Chronic kidney disease; Dialysis; Morbidity; Mortality; Outcomes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses flow diagram
Fig. 2
Fig. 2
Meta-analysis of differences in mortality between chronic kidney disease (CKD) and non-CKD groups in studies based on administrative data. a odds ratio. b hazard ratio
Fig. 3
Fig. 3
Meta-analysis of differences in mortality between dialysis and non-dialysis groups in studies based on administrative data
Fig. 4
Fig. 4
Meta-analysis of differences in mortality between chronic kidney disease (CKD) and non-CKD groups in studies based on hospital data
Fig. 5
Fig. 5
Meta-analysis of differences in periprosthetic joint infection (PJI) between chronic kidney disease (CKD) and non-CKD groups in studies based on administrative data
Fig. 6
Fig. 6
Meta-analysis of differences in periprosthetic joint infection (PJI) between dialysis and non-dialysis groups in studies based on administrative data
Fig. 7
Fig. 7
Meta-analysis of differences in periprosthetic joint infection (PJI) between chronic kidney disease (CKD) and non-CKD groups in studies based on hospital data
Fig. 8
Fig. 8
Meta-analysis of differences in revision surgery between chronic kidney disease (CKD) and non-CKD groups in studies based on administrative data
Fig. 9
Fig. 9
Meta-analysis of differences in revision surgery between dialysis and non-dialysis groups in studies based on administrative data
See this image and copyright information in PMC

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