Research Papers:

Chronic kidney disease is associated with a risk of higher mortality following total knee arthroplasty in diabetic patients: a nationwide population-based study

Liang-Tseng Kuo, Su-Ju Lin, Chi-Lung Chen, Pei-An Yu, Wei-Hsiu Hsu _ and Tien-Hsing Chen

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Oncotarget. 2017; 8:100288-100295. https://doi.org/10.18632/oncotarget.22215

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Liang-Tseng Kuo1,2,, Su-Ju Lin3, Chi-Lung Chen1, Pei-An Yu1, Wei-Hsiu Hsu1,4,* and Tien-Hsing Chen5,*

1Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

2Chang Gung University of Science and Technology, Chiayi, Taiwan

3Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan

4College of Medicine, Chang Gung University, Taoyuan, Taiwan

5Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan

*These authors have contributed equally to this work

Correspondence to:

Wei-Hsiu Hsu, email: 7572@cgmh.org.tw

Tien-Hsing Chen, email: skyheart0826@gmail.com

Keywords: total knee arthroplasty; diabetes mellitus; chronic kidney disease; mortality; periprosthetic joint infection

Received: August 16, 2017     Accepted: September 24, 2017     Published: October 31, 2017


Diabetes and chronic kidney disease (CKD) are associated with a higher rate of complications in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine the effects of CKD and diabetes in patients after TKA. Diabetic patients who received unilateral primary TKA between January 2008 and December 2011 were enrolled. The follow-up period was more than 6 months. The primary outcome was a TKA-related infection and the secondary outcome was all-cause mortality. The study cohort included 13844 patients who were followed for a mean period of 2 years, of whom 1459 (10.5%) had CKD. The patients with CKD were older than those without CKD (71.6 versus 70.3 years, P<0.0001) and had higher rates of hypertension, gouty arthritis, ischemic heart disease, chronic pulmonary obstructive disease, pulmonary embolism and deep vein thrombosis (all P<0.0001). After adjustment of comorbidities, the CKD group had a higher incidence of urinary tract infections (OR: 1.61, 95% CI: 1.19-2.17). There were no significant differences in wound infections, pneumonia, pulmonary embolism or in-hospital death between the two groups. After adjustment of confounders, the CKD group had higher rates of myocardial infarction (HR: 2.06, 95% CI: 1.26–3.39) and mortality (HR: 1.99, 95% CI: 1.59–2.48). The risk of TKA-related infection during follow-up was comparable between the two groups (HR: 1.31, 95% CI: 0.94–1.82). In conclusion, CKD is associated with increased risks of urinary tract infections, myocardial infarction and all-cause mortality after TKA. Surgeons should be aware of this when evaluating TKA patients with renal disease.

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