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. 2023 Feb;15(2):591-605.
doi: 10.1111/os.13589. Epub 2022 Dec 1.

A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease

Hongfu Jin  1   2 , Miao He  1   2 , Guang Yang  1   2 , Wenqing Xie  1   2 , Dengjie Yu  1   2 , Hengzhen Li  1   2 , Wenfeng Xiao  1   2 , Yusheng Li  1   2
Affiliations

A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease

Hongfu Jin et al. Orthop Surg. 2023 Feb.

Abstract

Objective: With the rising prevalence of chronic kidney disease (CKD) and the increasing demand for joint arthroplasty, the management of CKD patients in the perioperative period of joint arthroplasty has become an issue worthy of attention for orthopedic surgeons. This study aimed to explore comprehensive perioperative period management strategies for CKD patients.

Methods: From March 2017 to August 2022, 62 patients who underwent joint arthroplasty in our hospital were included in a retrospective study, including 31 CKD patients (mean age 69.8 ± 13.4 years old) and 31 non-CKD patients (mean age 69.4 ± 14.2 years old). The outcome indicators were analyzed, including serum urea, serum creatinine, blood uric acid, hematocrit, and hemoglobin.

Results: All patients included in the retrospective study had an average preoperative preparation time of 4.3 ± 2.6 days and an average hospitalization time of 11.0 ± 7.3 days. There were no significant differences in the changes in the serum urea values between the preoperative and postoperative measurements in the CKD patients or in the serum creatinine values and blood uric acid values (P > 0.05). The hemoglobin value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.05). The hematocrit value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.001).

Conclusion: Patients with CKD have distinct characteristics compared to non-CKD patients, and they generally have a higher risk for postoperative complications and adverse events. Recognition of risk factors, suitable timing of surgery, the undertaking of protective strategies, and proper management of complications are vital for managing CKD patients in the perioperative period of joint arthroplasty.

Keywords: Chronic kidney disease; Joint arthroplasty; Perioperative period; Renal function.

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Figures

Fig. 1
Fig. 1
Flow chart showing the of our study.
Fig. 2
Fig. 2
The serum urea values of CKD patients compared to the non‐CKD patients in the Perioperative Period. (A) Comparison of serum urea between the preoperative and postoperative measurements in CKD patients and non‐CKD patients. (B) Comparison of serum urea values in the preoperative measurements among the subgroups (THA, TKA, and FHR); (B) Comparison of serum urea values in the postoperative measurements among the subgroups (THA, TKA, and FHR). Notes: ns: not significant; **P < 0.01, ***P < 0.001.
Fig. 3
Fig. 3
The serum creatinine values of CKD patients compared to the non‐CKD patients in the Perioperative Period. (A) Comparison of serum creatinine between the preoperative and postoperative measurements in CKD patients and non‐CKD patients. (B) Comparison of serum creatinine values in the preoperative measurements among the subgroups (THA, TKA, and FHR); (B) Comparison of serum creatinine values in the postoperative measurements among the subgroups (THA, TKA, and FHR). Notes: ns: not significant; **P < 0.01, ***P < 0.001.
Fig. 4
Fig. 4
The blood uric acid values of CKD patients compared to the non‐CKD patients in the Perioperative Period. (A) Comparison of serum creatinine between the preoperative and postoperative measurements in CKD patients and non‐CKD patients. (B) Comparison of serum creatinine values in the preoperative measurements among the subgroups (THA, TKA, and FHR); (B) Comparison of serum creatinine values in the postoperative measurements among the subgroups (THA, TKA, and FHR). Notes: ns: not significant; **P < 0.01, ***P < 0.001.
Fig. 5
Fig. 5
The individual hemoglobin values of CKD patients compared to the non‐CKD patients in the Perioperative Period. (A) Comparison of hemoglobin values between the preoperative and postoperative measurements in CKD patients and non‐CKD patients. (B) Comparison of hemoglobin values in the preoperative measurements among the subgroups (THA, TKA, and FHR); (B) Comparison of hemoglobin values in the postoperative measurements among the subgroups (THA, TKA, and FHR). Notes: ns: not significant; *P < 0.05.
Fig. 6
Fig. 6
The hematocrit values of CKD patients compared to the non‐CKD patients in the Perioperative Period. (A) Comparison of hematocrit values between the preoperative and postoperative measurements in CKD patients and non‐CKD patients. (B) Comparison of hematocrit values in the preoperative measurements among the subgroups (THA, TKA, and FHR); (B) Comparison of hematocrit values in the postoperative measurements among the subgroups (THA, TKA, and FHR). Notes: ns: not significant; **P < 0.01, ***P < 0.001.
Fig. 7
Fig. 7
The preoperative and postoperative radiographic changes in the hip joints of one elderly patient with CKD (Anteroposterior Pelvic Radiograph). (A) The femoral heads' bone mineral density (BMD) was inhomogeneous, and there were low‐density zones under the articular surface. The lesion at the right is distinct compared with the left side. (B) The artificial joint was visible in the right hip joint with a good position and no radiological signs of implant loosening.
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