Chou Te-Feng Arthur, Ma Hsuan-Hsiao, Tsai Shang-Wen, Chen Cheng-Fong, Wu Po-Kuei, Chen Wei-Ming
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
EFORT Open Rev. 2021 Aug 10;6(8):618-628. doi: 10.1302/2058-5241.6.200116. eCollection 2021 Aug.
Patients with end-stage renal disease (ESRD) have inferior outcomes after hip and knee total joint arthroplasty (TJA), with higher risk for surgical site complications (SSC) and periprosthetic joint infection (PJI).We conducted a systematic review and meta-analysis regarding outcomes after hip and knee TJA in ESRD patients who have received dialysis or a kidney transplant (KT) using PubMed, MEDLINE, Cochrane Reviews, and Embase in order to: (1) determine the mortality and infection rate of TJA in patients receiving dialysis or KT and (2) to identify risk factors associated with the outcome.We included 22 studies and 9384 patients (dialysis, = 8921, KT, = 463). The overall mortality rate was 14.9% and was slightly higher in KT patients (dialysis vs. KT, 13.8% vs. 15.8%). The overall SSC rate was 3.4%, while dialysis and KT patients each had an incidence of 3.3% and 3.6%, respectively. For PJI, the overall rate was 3.9%, while the incidence for dialysis patients was 4.0% and for KT patients was 3.7%.Using multi-regression analysis, age, sex, the type of arthroplasty (knee or hip) performed, and the form of renal replacement therapy (dialysis or KT) were not significant risk factors.In patients on dialysis or who had received a KT, TJA is associated with a slight increase in mortality, SSC and PJI rates. Cite this article: 2021;6:618-628. DOI: 10.1302/2058-5241.6.200116.
终末期肾病（ESRD）患者在髋膝关节全关节置换术（TJA）后预后较差，手术部位并发症（SSC）和假体周围关节感染（PJI）风险更高。我们使用PubMed、MEDLINE、Cochrane综述和Embase对接受透析或肾移植（KT）的ESRD患者髋膝关节TJA后的预后进行了系统评价和荟萃分析，目的是：（1）确定接受透析或KT患者TJA的死亡率和感染率；（2）识别与预后相关的危险因素。我们纳入了22项研究和9384例患者（透析患者8921例，KT患者463例）。总体死亡率为14.9%，KT患者略高（透析患者与KT患者，分别为13.8%和15.8%）。总体SSC发生率为3.4%，透析患者和KT患者的发生率分别为3.3%和3.6%。对于PJI，总体发生率为3.9%，透析患者发生率为4.0%，KT患者发生率为3.7%。使用多元回归分析，年龄、性别、所进行的关节置换术类型（膝关节或髋关节）以及肾脏替代治疗形式（透析或KT）均不是显著危险因素。在接受透析或KT的患者中，TJA与死亡率、SSC和PJI发生率的轻微增加相关。引用本文：2021；6：618 - 628。DOI：10.1302/2058 - 5241.6.200116。
