Kildow Beau J, Agaba Perez, Moore Brian F, Hallows Rhett K, Bolognesi Michael P, Seyler Thorsten M
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Arthroplasty. 2017 Sep;32(9S):S135-S140.e1. doi: 10.1016/j.arth.2017.01.018. Epub 2017 Jan 21.
The prevalence of diabetes mellitus (DM), chronic kidney disease (CKD), hemodialysis (HD), and renal transplantation (RT) is increasing. This study assessed postoperative complications among diabetic patients with CKD, HD, or post-RT after total hip arthroplasty (THA).
Four cohorts were created using a nationwide database: DM&THA, DM&CKD&THA, DM&HD&THA, and DM&RT&THA. Cohorts were matched to a control group by age and gender. Thirty-day medical complications and 90-day and 2-year surgical complications were evaluated.
All 30-day complications were higher in each cohort. Ninety-day and 2-year surgical complications in the DM&HD&THA cohort were increased compared to the DM&RT&THA cohort. Remarkably, no increased risk of periprosthetic joint infection, periprosthetic fracture, or revision was noted post-THA in the DM&RT&THA cohort.
Diabetic patients with worsening kidney function are associated with increased post-THA complications. Postsurgical risks decline following RT. Diabetic patients with kidney failure may want to undergo RT prior to THA to optimize surgical outcomes.
糖尿病（DM）、慢性肾脏病（CKD）、血液透析（HD）及肾移植（RT）的患病率正在上升。本研究评估了全髋关节置换术（THA）后患有CKD、HD或肾移植后的糖尿病患者的术后并发症。
利用全国性数据库创建了四个队列：DM&THA、DM&CKD&THA、DM&HD&THA和DM&RT&THA。各队列按年龄和性别与对照组进行匹配。评估了30天的医疗并发症以及90天和2年的手术并发症。
每个队列的所有30天并发症发生率均较高。与DM&RT&THA队列相比，DM&HD&THA队列的90天和2年手术并发症有所增加。值得注意的是，DM&RT&THA队列在THA后未发现假体周围关节感染、假体周围骨折或翻修风险增加。
肾功能恶化的糖尿病患者THA术后并发症增加。肾移植后手术风险降低。肾衰竭的糖尿病患者可能希望在THA之前接受肾移植以优化手术结果。
