Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia.
J Bone Joint Surg Am. 2022 Apr 6;104(Suppl 2):90-94. doi: 10.2106/JBJS.20.00352.
Osteonecrosis of the femoral head (ONFH) is a potentially debilitating condition, often requiring total hip arthroplasty (THA). Patients on hemodialysis (HD) are at increased risk for complications after THA for osteoarthritis, however there is limited information on outcomes of THA for ONFH in patients on HD. With increasing prevalence of chronic kidney disease (CKD) requiring HD, studies are needed to characterize the risk of complications in these patients. Therefore, the purpose of this study was to evaluate HD as a potential risk factor for complication after THA in patients with ONFH on HD.
Patients on HD with ONFH who underwent THA with at least 2 years of follow-up were identified using a combination of ICD-9 and CPT codes in a national insurance database. A 10:1 matched control cohort of patients with ONFH not on HD was created for comparison. A logistic regression analysis was used to evaluate rates of death, hospital readmission, emergency room (ER) visit, infection, revision, and dislocation between cohorts. Differences in hospital charges, reimbursement, and length of stay between the two groups were also assessed.
One thousand one hundred thirty-seven patients on HD who underwent THA for ONFH were compared to a matched control cohort of 11,182 non-HD patients who underwent THA for ONFH. Patients on HD experienced higher rates of death (HD 4.1%, non-HD 0.9%; odds ratio [OR] 3.35, p < 0.01), hospital readmission (HD 16.1%, non-HD 5.9%; OR 2.69, p < 0.01) and ER visit (HD 10.4%, non-HD 7.4% OR 1.5, p < 0.01). Hemodialysis was not associated with higher risk of infection, revision, or dislocation, but was associated with significantly higher charges (p < 0.01), reimbursement (p < 0.01), and hospital length of stay (p < 0.01).
While patients on HD do not have increased risk of implant-related complications, they are at increased risk of developing medical complications following THA for ONFH and subsequently may require more resources. Orthopedic surgeons and nephrologists should be cognizant of the increased risk in this population to provide appropriate preoperative counseling and enhanced perioperative medical management.
Therapeutic Level III.
股骨头坏死（ONFH）是一种潜在的使人虚弱的疾病，通常需要全髋关节置换术（THA）。接受血液透析（HD）的患者在接受 THA 治疗骨关节炎后发生并发症的风险增加，但是关于接受 HD 的 ONFH 患者接受 THA 的结果的信息有限。随着需要 HD 的慢性肾脏病（CKD）的患病率增加，需要研究这些患者发生并发症的风险。因此，本研究的目的是评估 HD 是否为接受 HD 的 ONFH 患者接受 THA 后发生并发症的潜在危险因素。
使用 ICD-9 和 CPT 代码的组合，从全国性保险数据库中确定接受至少 2 年随访的接受 HD 的 ONFH 患者，并对其进行 THA。为了进行比较，创建了一个接受 HD 的 ONFH 患者的 10：1 匹配对照队列。使用逻辑回归分析评估两组之间的死亡率，住院再入院率，急诊室（ER）就诊率，感染率，翻修率和脱位率。还评估了两组之间的住院费用，报销和住院时间的差异。
将 1137 名接受 HD 的 ONFH 患者与接受 THA 治疗的 11182 名非 HD 患者进行了比较，该患者接受了非 HD 的 ONFH。接受 HD 的患者的死亡率（HD 4.1％，非 HD 0.9％；优势比[OR] 3.35，p <0.01），住院再入院率（HD 16.1％，非 HD 5.9％； OR 2.69，p <0.01）和 ER 就诊率（HD 10.4％，非 HD 7.4％OR 1.5，p <0.01）更高。血液透析与感染，翻修或脱位的风险增加无关，但与费用显着增加（p <0.01），报销（p <0.01）和住院时间延长（p <0.01）有关。
尽管接受 HD 的患者植入物相关并发症的风险没有增加，但他们在接受 THA 治疗 ONFH 后发生医疗并发症的风险增加，随后可能需要更多的资源。骨科医生和肾病医生应意识到该人群的风险增加，以便提供适当的术前咨询和增强围手术期医疗管理。
治疗 III 级。
