Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
J Arthroplasty. 2020 Jan;35(1):224-228. doi: 10.1016/j.arth.2019.08.045. Epub 2019 Aug 27.
There is little literature concerning clinical outcomes following revision joint arthroplasty in solid organ transplant recipients. The aims of this study are to (1) analyze postoperative outcomes and mortality following revision hip and knee arthroplasty in renal transplant recipients (RTRs) compared to non-RTRs and (2) characterize common indications and types of revision procedures among RTRs.
A retrospective Medicare database review identified 1020 RTRs who underwent revision joint arthroplasty (359 revision total knee arthroplasty [TKA] and 661 revision total hip arthroplasty [THA]) from 2005 to 2014. RTRs were compared to their respective matched control groups of nontransplant revision arthroplasty patients for hospital length of stay, readmission, major medical complications, infections, septicemia, and mortality following revision.
Renal transplantation was significantly associated with increased length of stay (6.12 ± 7.86 vs 4.33 ± 4.29, P < .001), septicemia (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.83-3.46; P < .001), and 1-year mortality (OR, 2.71; 95% CI, 1.51-4.53; P < .001) following revision TKA. Among revision THA patients, RTR status was associated with increased hospital readmission (OR, 1.23; 95% CI, 1.03-1.47; P = .023), septicemia (OR, 1.82; 95% CI, 1.41-2.34; P < .001), and 1-year mortality (OR, 2.65; 95% CI, 1.88-3.66; P < .001). The most frequent primary diagnoses associated with revision TKA and THA among RTRs were mechanical complications of prosthetic implant.
Prior renal transplantation among revision joint arthroplasty patients is associated with increased morbidity and mortality when compared to nontransplant recipients.
关于实体器官移植受者翻修关节置换术后的临床结果，文献资料很少。本研究的目的是：（1）分析肾移植受者（RTR）与非 RTR 相比，翻修髋关节和膝关节置换术后的术后结果和死亡率；（2）描述 RTR 中常见的翻修手术适应证和类型。
回顾性 Medicare 数据库研究，纳入了 2005 年至 2014 年间 1020 例接受翻修关节置换术（359 例翻修全膝关节置换术[TKA]和 661 例翻修全髋关节置换术[THA]）的 RTR。将 RTR 与各自的非移植翻修关节置换术患者的匹配对照组进行比较，比较项目包括住院时间、再入院、主要医疗并发症、感染、败血症和翻修后的死亡率。
与 RTR 相比，肾移植与翻修 TKA 后的住院时间延长（6.12±7.86 与 4.33±4.29，P<0.001）、败血症（比值比[OR]，2.52；95%置信区间[CI]，1.83-3.46；P<0.001）和 1 年死亡率（OR，2.71；95% CI，1.51-4.53；P<0.001）增加有关。在翻修 THA 患者中，RTR 状态与住院再入院（OR，1.23；95% CI，1.03-1.47；P=0.023）、败血症（OR，1.82；95% CI，1.41-2.34；P<0.001）和 1 年死亡率（OR，2.65；95% CI，1.88-3.66；P<0.001）增加有关。与 RTR 翻修 TKA 和 THA 相关的最常见的主要诊断是假体植入的机械并发症。
与非移植受者相比，翻修关节置换术患者的既往肾移植与发病率和死亡率增加有关。
