Analysis about Complications of Hip Arthroplasty in Patients with Chronic Renal Failure on Hemodialysis

Jae-Hwi Nho; Hyung-Suk Choi; Kang-Hee Park; Jong-Seok Park; You-Sung Suh

doi:10.4055/jkoa.2011.46.3.222

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Nho, Choi, Park, Park, and Suh: Analysis about Complications of Hip Arthroplasty in Patients with Chronic Renal Failure on Hemodialysis

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(3): 222-230.

Published online: 30 June 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.3.222

Analysis about Complications of Hip Arthroplasty in Patients with Chronic Renal Failure on Hemodialysis

Jae-Hwi Nho, M.D., Hyung-Suk Choi, M.D., Kang-Hee Park, M.D., Jong-Seok Park, M.D., You-Sung Suh, M.D.

Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Seoul, Korea.

Correspondence to: You-Sung Suh, M.D. Department of Orthopaedic Surgery, Soonchunhyang University Hospital, 22, Daesagwan-gil(657 Hannam-dong), Yongsan-gu, Seoul 140-743, Korea. TEL: +82-2-709-9250, FAX: +82-2-794-9414, yssuh@schmc.ac.kr

Received 29 October 2010 Accepted 25 January 2011

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

In general, the results and prognosis of surgical treatment in dialysis patients are poor compared to patients with normal kidney function. This study analyzes the complications in chronic renal failure patients who underwent primary hip arthroplasty for hip fractures and arthropathy. Orthopaedic complications and medical complications were analyzed for a consequential difference.

Materials and Methods

Between 2003 and 2008, 38 dialysis patients (40 cases) with chronic renal failure were enrolled with 24 cases of bipolar hemiarthroplasty and 16 cases of total hip arthroplasty. Types and rates of orthopaedic and medical complications were investigated. Patients were classified according to age, gender, duration of dialysis and diabetes mellitus status. Complications were analyzed for each group.

Results

Complications occurred in 15 patients (overall complication rate: 37.5%). Eight patients were died within 1 year (mortality: 20%). Gender and duration of dialysis were not correlated to number of complications. However, there were significant differences according to age (p=0.014) and having diabetes (p=0.026). With regard to mortality, there was no significant difference according to the above classification.

Conclusion

Patients on hemodialysis have a high risk of complications after primary hip arthroplasty, especially in elderly patients and diabetic patients. Therefore, we require a full disclosure before recommending hip arthroplasty surgery in dialysis patients, and close postoperative care in patients undergoing dialysis.

Keywords: dialysis, chronic renal failure, arthroplasty, complication, hip

Figures and Tables

Figure 1

Radiographs of a 77-year-old woman who had diabetic nephropathy undergoing hemodialysis treated with left total hip arthroplasty. (A) Preoperative radiograph shows left hip osteoarthritis. (B) Immediate postoperative radiograph shows missed intraoperative periprosthetic fracture around distal portion of the stem. (C) After 2 months of treating with long leg brace, callus formation was obtained. But after removal of brace, the patient had recurrent dislocation. (D) Revision arthroplasty was done changing the liner to a constrained liner.

Table 1

Summary of Demographic Data

THA, total hip arthroplasty.

Table 2

Overall Incidence of Complications of Patients Undergoing Hemodialysis after Hip Arthroplasties

Table 3

Result of Complication Rates and Mortality according to Age, Gender, Duration of Hemodialysis and Accompanying Diabetes

CI, confidence interval.

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