The Journal Of Bone And Joint Surgery - Volume 97 - Issue 16 - p. 1326-1332

Inpatient Mortality and Morbidity for Dialysis-Dependent Patients Undergoing Primary Total Hip or Knee Arthroplasty

Ponnusamy Karthikeyan E., MD; Jain Amit, MD; Thakkar Savyasachi C., MD; Sterling Robert S., MD; Skolasky Richard L., ScD; Khanuja Harpal S., MD
Hip Knee
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.
Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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