Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis

Te-Feng Arthur Chou; Hsuan-Hsiao Ma; Shang-Wen Tsai; Cheng-Fong Chen; Po-Kuei Wu; Wei-Ming Chen

doi:10.1302/2058-5241.6.200116

Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis

EFORT Open Rev. 2021 Aug 10;6(8):618-628. doi: 10.1302/2058-5241.6.200116. eCollection 2021 Aug.

Authors

Te-Feng Arthur Chou^{1

2}, Hsuan-Hsiao Ma^{1

2}, Shang-Wen Tsai^{1

2}, Cheng-Fong Chen^{1

2}, Po-Kuei Wu^{1

2}, Wei-Ming Chen^{1

2}

Affiliations

¹ Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
² Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.

Abstract

Patients with end-stage renal disease (ESRD) have inferior outcomes after hip and knee total joint arthroplasty (TJA), with higher risk for surgical site complications (SSC) and periprosthetic joint infection (PJI).We conducted a systematic review and meta-analysis regarding outcomes after hip and knee TJA in ESRD patients who have received dialysis or a kidney transplant (KT) using PubMed, MEDLINE, Cochrane Reviews, and Embase in order to: (1) determine the mortality and infection rate of TJA in patients receiving dialysis or KT and (2) to identify risk factors associated with the outcome.We included 22 studies and 9384 patients (dialysis, n = 8921, KT, n = 463). The overall mortality rate was 14.9% and was slightly higher in KT patients (dialysis vs. KT, 13.8% vs. 15.8%). The overall SSC rate was 3.4%, while dialysis and KT patients each had an incidence of 3.3% and 3.6%, respectively. For PJI, the overall rate was 3.9%, while the incidence for dialysis patients was 4.0% and for KT patients was 3.7%.Using multi-regression analysis, age, sex, the type of arthroplasty (knee or hip) performed, and the form of renal replacement therapy (dialysis or KT) were not significant risk factors.In patients on dialysis or who had received a KT, TJA is associated with a slight increase in mortality, SSC and PJI rates. Cite this article: EFORT Open Rev 2021;6:618-628. DOI: 10.1302/2058-5241.6.200116.

Keywords: complication; dialysis; kidney transplant; mortality; periprosthetic joint infection; renal transplant; total hip arthroplasty; total knee arthroplasty.

Publication types

Review