Total hip arthroplasty complications in patients with chronic kidney disease: A comparison study

Jake A Fox; Grayson A Domingue; Christian V DeMaio; Bryan S Brockman; Kimberly Malloy; Rishi Thakral

doi:10.1016/j.jor.2023.03.013

Total hip arthroplasty complications in patients with chronic kidney disease: A comparison study

J Orthop. 2023 Apr 1:39:1-6. doi: 10.1016/j.jor.2023.03.013. eCollection 2023 May.

Authors

Jake A Fox¹, Grayson A Domingue², Christian V DeMaio³, Bryan S Brockman⁴, Kimberly Malloy⁵, Rishi Thakral²

Affiliations

¹ Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
² University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Oklahoma City, OK 73104, USA.
³ University of Oklahoma College of Medicine, 940 Stanton L Young Blvd, Oklahoma City, OK 73104, USA.
⁴ Baptist Health South Florida, 6855 Red Rd Ste 500, Coral Gables, Florida 33143, USA.
⁵ University of Oklahoma College of Public Health, 801 NE 13th St, Oklahoma City, OK, 73104 USA.

Abstract

Background: It has been noted in the literature that there are increased complication rates following total hip arthroplasty (THA) in patients with chronic kidney disease (CKD) or end stage renal disease (ESRD). However, there is little data directly comparing outcomes in patients undergoing THA for osteoarthritis (OA) versus ESRD or CKD with OA. The objective of this study is to illustrate the risk of developing postoperative complications after THA in the CKD and ESRD populations by stage of disease when compared to a control group (OA) and thus better equip orthopaedic providers in the care of these patients.

Methods: The National Inpatient Sample (NIS) was utilized to identify patients undergoing elective THA from 2006 to 2015 with OA, ESRD, and CKD. The prevalence of preoperative comorbidities and the incidence of numerous postoperative complications broken into categories were examined.

Results: Between 2006 and 2015 the NIS database reported 4,350,961 patients diagnosed with OA, 8355 diagnosed with ESRD, and 104,313 diagnosed with CKD undergoing THA. The incidence of wound hematoma (2.5% vs. 0.8%; p < .0001), wound infection (0.7% vs. 0.4%; p = .0319), cardiac (1.3% vs. 0.6%; p = .0067), urinary (3.9% vs. 2.0%; p < .0001), and pulmonary complications (2.2% vs. 0.5%; p < .0001) occurred more frequently in patients with OA and ESRD when compared to only OA patients. For patients with OA and CKD, stages 3-5 saw at least half of the complication categories occur at significantly higher rates than OA patients.

Conclusion: This study shows that patients with ESRD and CKD have increased rates of complications after THA. This study's specific breakdown by stage and complication can benefit orthopaedic surgeons and practitioners in realistic pre and postoperative planning and provides data that could benefit decision making on bundled reimbursement for this specific patient population, as providers could better account for the postoperative complications noted above and their associated costs.

Keywords: Chronic kidney disease; Hip arthroplasty; Osteoarthritis; Outcomes; Perioperative morbidity.