Lizaur-Utrilla Alejandro, Martinez-Mendez Daniel, Collados-Maestre Isabel, Marco-Gómez Luis, Lopez-Prats Fernando A
Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Traumatology and Orthopaedia, Miguel Hernandez University, Elche, Alicante, Spain.
Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain.
J Arthroplasty. 2016 Oct;31(10):2152-5. doi: 10.1016/j.arth.2016.03.049. Epub 2016 Apr 4.
The purpose of this study was to compare outcomes and complications after total knee arthroplasty (TKA) between end-stage renal disease (ESRD) patients and patients without renal insufficiency.
A retrospective case-control study with prospectively collected data was carried out to compare 15 ESRD patients with a matched cohort of 30 nonrenal patients. Clinical evaluation was performed by the Knee Society Scores (KSS) and reduced Western Ontario MacMasters University (WOMAC) questionnaire. Radiologic evaluation was also performed.
The mean postoperative follow-up was 3.4 years (range, 2-6). In the ESRD, the mean hospital stay and transfusion rate were significantly higher than control group. Preoperatively and postoperatively, there were no significant differences in KSS-knee or WOMAC-pain scores, but KSS-function and WOMAC-function were significantly lower in the ESRD group. There was no significant difference between groups in mean gain of KSS-function (45.1 vs 43.2, P = .071), but there was a significant lower mean gain for WOMAC-function in the ESRD group (37.0 vs 44.0, P = .003). In the ESRD group, 3 patients presented medical complications which were treated successfully. There were 2 superficial infections and no deep infection. One patient died at 30 postoperative months. In the control group, there were no medical complications, infections, or deaths during the follow-up period. In ESRD group, there were 2 knees with radiolucent lines. In either group, there was no loosening or revision.
TKA was a successful procedure for knee osteoarthritis in most ESRD patients. Dialysis patients may expect improvement in function after TKA, but the patients need to be informed of the possible risk of postoperative severe medical complications due to nature of their renal disease.
本研究旨在比较终末期肾病（ESRD）患者与无肾功能不全患者全膝关节置换术（TKA）后的疗效及并发症。
进行一项回顾性病例对照研究，采用前瞻性收集的数据，比较15例ESRD患者与30例非肾病对照患者。通过膝关节协会评分（KSS）和简化的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）问卷进行临床评估。还进行了影像学评估。
术后平均随访3.4年（范围2 - 6年）。在ESRD患者中，平均住院时间和输血率显著高于对照组。术前和术后，KSS膝关节评分或WOMAC疼痛评分无显著差异，但ESRD组的KSS功能评分和WOMAC功能评分显著较低。两组间KSS功能评分的平均增加无显著差异（45.1对43.2，P = 0.071），但ESRD组WOMAC功能评分的平均增加显著较低（37.0对44.0，P = 0.003）。在ESRD组中，3例患者出现内科并发症，均成功治疗。有2例表浅感染，无深部感染。1例患者在术后30个月死亡。在对照组中，随访期间无内科并发症、感染或死亡。在ESRD组中，有2个膝关节出现透亮线。两组均无松动或翻修情况。
对于大多数ESRD患者，TKA是治疗膝关节骨关节炎的成功手术。透析患者TKA后功能有望改善，但因其肾病性质，需要告知患者术后可能出现严重内科并发症的风险。
