Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
J Arthroplasty. 2018 Mar;33(3):872-877. doi: 10.1016/j.arth.2017.09.058. Epub 2017 Oct 6.
Total hip arthroplasty in patients with end-stage renal disease (ESRD) may be associated with a high complication rate. However, the perioperative complication and mortality rates in these patients after total knee arthroplasty (TKA) have rarely been investigated. The purposes of this study were to measure the mortality and complication rates and to evaluate the 2- to 10-year clinical outcome of TKA in dialysis patients at our hospital during the past decade.
We retrospectively assessed 21 patients (26 knees) with ESRD who underwent primary TKA between 2007 and 2015. A preoperative medical evaluation was performed in all patients to assess the risk of surgery. All patients had complete clinical and radiographic evaluations, and the outcome was scored using American Knee Society Scores and the Western Ontario and McMaster Universities Arthritis Index. Perioperative complications and mortality were recorded.
One patient died of stroke 1 year after surgery (4.8% mortality). The mean follow-up period of other 20 patients was 5.8 years (69.7 months, 24 to 119 months). Six patients (28.5%) had medical complications, including pneumonia (n = 3), stroke (n = 2), and cardiovascular events (n = 3), after discharge from hospital. At the latest follow-up, 19 patients (90.5%) had improved clinical outcomes of the knee after TKA according to the American Knee Society Scores (P < .01) and Western Ontario and McMaster Universities Arthritis Index scores (P < .01).
Our study showed that TKA was a valid option for dialysis patients after careful preoperative evaluation. Most patients had an improved clinical outcome. There were no instances of prosthetic loosening or deep infection. However, dialysis patients under consideration for TKA need to be informed of the risk of possible medical complications due to the nature of ESRD.
终末期肾病（ESRD）患者行全髋关节置换术可能会伴随较高的并发症发生率。然而，有关此类患者行全膝关节置换术（TKA）后的围手术期并发症和死亡率鲜有报道。本研究旨在评估过去十年我院透析患者行 TKA 的死亡率和并发症发生率，并评估其 2 年至 10 年的临床疗效。
我们回顾性评估了 2007 年至 2015 年期间行初次 TKA 的 21 例（26 膝）ESRD 患者。所有患者均接受术前医学评估以评估手术风险。所有患者均接受了完整的临床和影像学评估，并采用美国膝关节协会评分（KSS）和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）进行评分。记录围手术期并发症和死亡率。
1 例患者（4.8%）术后 1 年死于中风。20 例患者的平均随访时间为 5.8 年（69.7 个月，24 至 119 个月）。6 例（28.5%）患者出院后出现医疗并发症，包括肺炎（n=3）、中风（n=2）和心血管事件（n=3）。末次随访时，19 例（90.5%）患者的膝关节 TKA 临床疗效较术前改善（美国膝关节协会评分：P<0.01；WOMAC 评分：P<0.01）。
本研究表明，对透析患者进行仔细的术前评估后，TKA 是一种有效的治疗选择。大多数患者的临床疗效得到改善。无假体松动或深部感染的病例。然而，考虑行 TKA 的透析患者需要了解因 ESRD 性质导致可能发生医疗并发症的风险。
