Hip hemiarthroplasty for the treatment of femoral neck fractures in dialysis patients

Effects of chronic kidney disease on complications and mortality after fracture surgery

PURPOSE

The purpose of this meta-analysis was to evaluate the effects of CKD on postoperative complications and the survival of patients with fractures.

METHODS

The PubMed, Embase, Cochrane Library, and CNKI databases were searched from inception to May 15, 2024. The search strategy focused on two keywords: dialysis and hip fracture. Pooled odds ratios and mean differences were analyzed. RevMan 5.4 was used for data analysis in this meta-analysis.

RESULTS

This meta-analysis included 19 studies involving 1,615,440 patients. The CKD group had higher proportions of males, smokers, and patients with preoperative comorbidities such as diabetes, hypertension, heart failure, chronic lung disease, coronary heart disease, peripheral vascular disease, dementia, and wound infection. The CKD group also had a greater likelihood of postoperative myocardial infarction (OR = 1.67, 95% CI = 1.54-1.81, P < 0.00001, I2 = 33%). There was no significant difference in cerebrovascular accidents, liver failure, sepsis, and overall complications between the two groups. Additionally, the CKD group had higher mortality rates at 30 days (OR = 2.71, 95% CI = 2.23-3.28, P < 0.00001, I2 = 84%), 1 year (OR = 3.17, 95% CI = 2.64-3.82, P < 0.00001, I2 = 85%), 2 years (OR = 3.06, 95% CI = 2.88-3.25, P < 0.00001, I2 = 8%), and 10 years (OR = 6.85, 95% CI = 5.84-8.03, P < 0.00001, I2 = 0%) post-surgery compared to the non-CKD group.

CONCLUSION

Compared with patients in the non-CKD group, patients in the CKD group did not significantly differ in the incidence of most postoperative complications after fracture surgery. However, the CKD group had a significantly greater incidence of myocardial infarction and markedly higher postoperative mortality rates at 30 days, 1 year, 2 years, and 10 years.

TRIAL REGISTRATION

PROSPERO CRD42025648208.

Unseen Threefold Mortality After the First Ten Days in Hemodialysis Patients Following Joint Arthroplasty: A Nationwide Retrospective Cohort Study of 1,287 Arthroplasty Patients on Hemodialysis

BACKGROUND

The study addresses the growing number of hemodialysis (HD) patients undergoing joint arthroplasty, who are at higher risk of complications and mortality. Previous research has often overlooked deaths after discharge. This study aimed to examine early outcomes in a large nationwide cohort of patients who underwent arthroplasty for elective and fracture-related reasons.

METHODS

Between 2016 and 2022, a study was conducted using the e-Nabız database of the Türkiye Ministry of Health, focusing on patients aged 18 years and above who underwent elective or fracture-related arthroplasty. This study included 1,287 patients reliant on dialysis who underwent total hip arthroplasty, total knee arthroplasty, or hemiarthroplasty (HA), with 7.7% of them receiving dialysis for the first time. Propensity score matching was used to create an equally sized group of non-dialysis-dependent patients, ensuring demographic balance in terms of age, sex, a comorbidity index, and surgery type. The primary objective was to compare mortality rates 10, 30, and 90 days after arthroplasty.

RESULTS

The first-time dialysis patients who underwent HA had significantly higher 30- and 90-day mortality rates compared to the chronic dialysis group (P = .040 and P < .001, respectively). Also, the HD patients consistently exhibited higher 90-day mortality rates across all surgery types. With total knee arthroplasty, HD patients had a mortality rate of 8.7%, in stark contrast to 0% among non-HD patients (P < .001). Similarly, with total hip arthroplasty, HD patients had a 12% mortality rate, while non-HD patients had a markedly lower rate of 2.7% (P = .008). In the case of HA, HD patients had a significantly elevated 90-day mortality rate of 31.9%, in contrast to 17.1% among non-HD patients (P < .001).

CONCLUSIONS

Joint arthroplasty has higher rates of mortality and complications among HD patients. Surgical decisions must be based on patients' overall health, necessitating collaboration among specialists. These patients should be closely monitored.