title: Elective Total Knee Arthroplasty in Patients With End-Stage Renal Disease: Is It a Safe Procedure?
abstract: The purpose of this study was to compare outcomes and complications after total knee arthroplasty (TKA) between end-stage renal disease (ESRD) patients and patients without renal insufficiency.
  
  
  
  A retrospective case-control study with prospectively collected data was carried out to compare 15 ESRD patients with a matched cohort of 30 nonrenal patients. Clinical evaluation was performed by the Knee Society Scores (KSS) and reduced Western Ontario MacMasters University (WOMAC) questionnaire. Radiologic evaluation was also performed.
  
  
  
  The mean postoperative follow-up was 3.4 years (range, 2-6). In the ESRD, the mean hospital stay and transfusion rate were significantly higher than control group. Preoperatively and postoperatively, there were no significant differences in KSS-knee or WOMAC-pain scores, but KSS-function and WOMAC-function were significantly lower in the ESRD group. There was no significant difference between groups in mean gain of KSS-function (45.1 vs 43.2, P = .071), but there was a significant lower mean gain for WOMAC-function in the ESRD group (37.0 vs 44.0, P = .003). In the ESRD group, 3 patients presented medical complications which were treated successfully. There were 2 superficial infections and no deep infection. One patient died at 30 postoperative months. In the control group, there were no medical complications, infections, or deaths during the follow-up period. In ESRD group, there were 2 knees with radiolucent lines. In either group, there was no loosening or revision.
  
  
  
  TKA was a successful procedure for knee osteoarthritis in most ESRD patients. Dialysis patients may expect improvement in function after TKA, but the patients need to be informed of the possible risk of postoperative severe medical complications due to nature of their renal disease.
authors.affiliation: Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Traumatology and Orthopaedia, Miguel Hernandez University, Elche, Alicante, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lizaur-Utrilla
authors.affiliation: Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martinez-Mendez
authors.affiliation: Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Collados-Maestre
authors.affiliation: Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Marco-Gómez
authors.affiliation: Traumatology and Orthopaedia, Miguel Hernandez University, Elche, Alicante, Spain.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Lopez-Prats
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016022:Case-Control Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D051436:Renal Insufficiency, Chronic; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: chronic renal disease; dialysis patient; end-stage renal disease; hemodialysis; total knee arthroplasty