Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: a retrospective cohort study

Chun-Ru Lin; Chune-Chen Lee; Yu-Feng Kuo; Shih-Pei Huang; Yong-Chen Chen; Shu-Hao Chang

doi:10.1016/j.otsr.2024.103847

Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: a retrospective cohort study

Orthop Traumatol Surg Res. 2024 Feb 26:103847. doi: 10.1016/j.otsr.2024.103847. Online ahead of print.

Authors

Chun-Ru Lin¹, Chune-Chen Lee², Yu-Feng Kuo³, Shih-Pei Huang⁴, Yong-Chen Chen⁵, Shu-Hao Chang⁶

Affiliations

¹ Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333423, (R.O.C.), Taiwan.
² Data Science Center, College of Medicine, Fu-Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 242062, Taiwan.
³ Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No. 69, Guizi Rd., Taishan Dist., New Taipei City 24352, Taiwan.
⁴ Department of Medical Education & Bioethics, Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei City 100233, Taiwan. Electronic address: a00414@mail.fjuh.fju.edu.tw.
⁵ Data Science Center, College of Medicine, Fu-Jen Catholic University - Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 242062, Taiwan.
⁶ Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No. 69, Guizi Rd., Taishan Dist., New Taipei City 24352 -School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 24205, Taiwan.

PMID: 38417784
DOI: 10.1016/j.otsr.2024.103847

Abstract

Background: Chronic kidney disease (CKD) is a prevalent condition in Taiwan, and the incidence of total knee arthroplasty (TKA) is on the rise. This study aimed to evaluate the postoperative results of patients with different degrees of CKD after TKA, using data from the Taiwan National Health Insurance Research Database.

Methods: The study analyzed 3,078 patients who received TKA from 2012 to 2017, equally divided into three groups: none-CKD, mild CKD (without dialysis), and severe CKD (with dialysis). Propensity score matching was used to minimize selection bias.

Results: After TKA, there was no significant difference in the risk of debridement surgery for infection between the three groups (adjusted HR of mild CKD 0.71 95% CI = 0.36 - 1.38, P = 0.3073; adjusted HR of severe CKD: 1.14, 95% CI = 0.63 - 2.06, P = 0.6616). However, CKD patients requiring dialysis had a significantly higher risk of mortality (adjusted HR 1.98, 95% CI = 1.57 - 2.50, P < 0.001) and readmission within 90 days of any causes (adjusted HR 1.83, 95% CI = 1.48 - 2.26, P < 0.001) than non-CKD and mild CKD patients.

Conclusion: Severe CKD patients needing dialysis after TKA have a higher risk of mortality and readmission rates than that of the non-CKD or mild CKD patients. If the patient is in the early stage of CKD, their prognosis after receiving TKA is expected to be as good as non-CKD patients.

Level of evidence: IV; well-designed cohort study.

Keywords: chronic kidney disease; comorbidity; dialysis; population-based study; postoperative complication; total knee arthroplasty.