Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: A retrospective cohort study.

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) is a prevalent condition in Taiwan, and the incidence of total knee arthroplasty (TKA) is on the rise. This study aimed to evaluate the postoperative results of patients with different degrees of CKD after TKA, using data from the Taiwan National Health Insurance Research Database. METHODS: The study analyzed 3078 patients who received TKA from 2012 to 2017, equally divided into three groups none-CKD, mild CKD (without dialysis), and severe CKD (with dialysis). Propensity score matching was used to minimize selection bias. RESULTS: After TKA, there was no significant difference in the risk of debridement surgery for infection between the three groups (adjusted HR of mild CKD 0.71 95% CI=0.36-1.38, p=0.3073; adjusted HR of severe CKD 1.14, 95% CI=0.63-2.06, p=0.6616). However, CKD patients requiring dialysis had a significantly higher risk of mortality (adjusted HR 1.98, 95% CI=1.57-2.50, p<0.001) and readmission within 90days of any causes (adjusted HR 1.83, 95% CI=1.48-2.26, p<0.001) than non-CKD and mild CKD patients. CONCLUSION: Severe CKD patients needing dialysis after TKA have a higher risk of mortality and readmission rates than that of the non-CKD or mild CKD patients. If the patient is in the early stage of CKD, their prognosis after receiving TKA is expected to be as good as non-CKD patients. LEVEL OF EVIDENCE IV; well-designed cohort study.