Can total knee arthroplasty be safely performed in patients with chronic renal disease?

Figures & data

Table 1. Primary total knee arthroplasty samples included in the study, overall and according to chronic renal disease status, 2005–2010

Chronic renal disease status
	Totaln = 41,852		Non = 34,196 (81.7%)		Yesn = 2,686 (6.4%)		p-value	Unknownn = 4,970 (11.9%)
	n	%	n	%	n	%		n	%
Sex
Female	26,058	62.3	21,420	62.6	1,607	59.8	0.004	3,031	61.0
Male	15,785	37.7	12,769	37.3	1,079	40.2		1,937	39.0
Unknown	9	0.0	7	0.0	0	0.0		2	0.0
Race/ethnicity
White	28,307	67.6	23,192	67.8	1,796	66.9	< 0.001	3,319	66.8
Hispanic	6,080	14.5	5,190	15.2	296	11.0		594	12.0
Black	3,786	9.1	3,098	9.1	347	12.9		341	6.9
Asian	2,241	5.4	1,918	5.6	186	6.9		137	2.8
Other/Multi	740	1.8	578	1.7	60	2.2		102	2.1
Unknown	698	1.7	220	0.6	1	0.0		477	9.6
ASA category
1 and 2	24,401	58.3	20,749	60.7	909	33.8	< 0.001	2,743	55.2
≥ 3	16,855	40.3	13,378	39.1	1,764	65.7		1,713	34.5
Unknown	596	1.4	69	0.2	13	0.5		514	10.3
Comorbidities
Diabetes	11,007	26.3	8,567	25.1	1,231	45.8	< 0.001	1,209	24.3
Congestive heart failure	1,203	2.9	894	2.6	309	11.5	< 0.001	–	–
Valvular disease	1,127	2.7	952	2.8	175	6.5	< 0.001	–	–
Peripheral vascular disease	1,326	3.2	1,051	3.1	275	10.2	< 0.001	–	–
Alcohol abuse	476	1.1	429	1.3	47	1.8	0.03	–	–
Hypertension	23,991	57.3	21,450	62.7	2,541	94.6	< 0.001	–	–
Diagnosis
Osteoarthritis	40,773	97.4	33,271	97.3	2,645	98.5	0.002	4,857	97.7
Osteonecrosis	162	0.4	136	0.4	7	0.3	0.3	19	0.4
Posttraumatic arthritis	430	1.0	362	1.1	13	0.5	0.004	55	1.1
Rheumatoid arthritis	814	1.9	685	2.0	39	1.5	0.05	90	1.8
	Median	Range	Median	Range	Median	Range		Median	Range
Age ^a	67	11–101	67	19–101	73	39–97	< 0.001	66	11–98
BMI, kg/m ^2 ^a	30.8	15.4–68.5	30.7	15.4–68.5	30.7	15.7–56.7	0.8	31.4	15.4–65.9
Operative time, min ^a	90	30–480	90	30–480	90	30–369	0.02	80	30–300
Length of stay ^b	3	0–33	3	0–33	3	1–24	< 0.001	3	2–8

BMI: body mass index; ASA: American Society of Anaesthesiologists score.

^a Unknown: age < 0.1%, BMI 0.4%, operative time 18%.

^b Length of stay available for limited sample, 2009 onwards (n = 18,821). Unknown: 13%.

Table 2. Frequencies and proportions of surgical outcomes for the total cohort and according to chronic renal disease status, 2005–2010

Chronic renal disease status
	Totaln = 41,852		Non = 34,196		Yesn = 2,686		Unknownn = 4,970
	n	%	n	%	n	%	n	%
Revision (any)	792	1.89	660	1.93	48	1.79	84	1.69
Septic revision	340	0.81	283	0.83	25	0.93	32	0.64
Aseptic revision	452	1.08	377	1.10	23	0.86	52	1.05
Surgical site infection (deep)	297	0.71	241	0.70	24	0.89	32	0.64
Surgical site infection (superficial)	130	0.31	106	0.31	14	0.52	10	0.20
Pulmonary embolism	211	0.50	175	0.51	15	0.56	21	0.42
Deep vein thrombosis	184	0.44	142	0.42	15	0.56	27	0.54
Mortality (any time)	1,043	2.49	827	2.42	125	4.65	91	1.83
Mortality within 30 days	52	0.12	46	0.13	4	0.15	2	0.04
Mortality within 90 days	101	0.24	81	0.24	11	0.41	9	0.18
Re-admission within 90 days ^a	1,053	5.59	889	5.98	164	10.35	–	–

^a Limited sample for re-admission data, 2009 onwards (n = 18,821). Unknown: 13%.

Figure 1. Kaplan-Meier survival estimates for TKA, with 95% confidence limits, according to whether or not the patients had chronic renal disease (CRD). Overall revisions. (N = 36,882, CRD = 2,682 and non-CRD = 34,196).

Figure 2. Kaplan-Meier survival estimates for TKA, with 95% confidence limits, according to whether or not the patients had chronic renal disease (CRD). Aseptic revisions only. (N = 36,574, CRD = 2,661 and non-CRD = 33,913).

Figure 3. Kaplan-Meier survival estimates for TKA, with 95% confidence limits, according to whether or not the patients had chronic renal disease (CRD). Mortality. (N = 36,882, CRD = 2,682 and non-CRD = 34,196).

Table 3. Crude and adjusted associations of outcomes in TKA cases with chronic kidney disease compared to TKA cases without chronic renal disease, 2005–2010 (n = 41,852)

	CrudeHR/OR	95% CI	p-value	Adjusted ^a HR/OR	95% CI	p-value
Hazard ratio – Time-dependent
Revision (any)	1.07	0.80–1.44	0.6	1.04	0.77–1.41	0.8
Aseptic revision	0.90	0.60–1.39	0.7	1.05	0.69–1.61	0.8
Mortality (any time)	2.76	2.28–3.35	< 0.001	1.49	1.21–1.83	< 0.001
Odds ratio – Not time-dependent
Septic revision	1.13	0.75–1.72	0.6	0.90	0.59–1.38	0.6
Surgical site infection (deep)	1.26	0.82–1.93	0.3	1.01	0.65–1.58	1.0
Surgical site infection (superficial)	1.73	0.98–3.06	0.06	1.92	1.05–3.50	0.04
Pulmonary embolism	1.10	0.64–1.88	0.7	0.91	0.52–1.60	0.7
Deep vein thrombosis	1.38	0.80–2.37	0.2	0.95	0.54–1.68	0.9
Mortality within 30 days	1.17	0.43–3.18	0.8	0.59	0.21–1.67	0.3
Mortality within 90 days	1.81	0.97–3.37	0.06	0.88	0.45–1.70	0.7
Re-admission within 90 days ^b	1.81	1.52–2.16	< 0.001	1.33	1.11–1.61	0.003

HR: hazard ratio; OR: odds ratio.

^a Models adjusted for age, sex, race/ethnicity, American Society of Anaesthesiologists scores, surgery indication

(osteoarthritis vs. other diagnosis), and comorbidities (diabetes, heart failure, valvular disease, peripheral vascu-

lar disease, alcohol abuse, and hypertension).

^b Limited sample for re-admission data, 2009 onwards (n = 18,821).