Total knee arthroplasty in patients with dialysis: early complications and mortality.

BACKGROUND: Total hip arthroplasty (THA) in patients on long-term hemodialysis may result in a high prevalence of complications which related to nature of the disease, and associated cardiovascular conditions. However, the result of total knee artrhopalsty (TKA) in those patients is not clear. The purpose of this study was to retrospectively evaluate the early mortality and complications of TKA performed in patients with dialysis.

METHODS: We retrospectively evaluated 15 dialysis patients (18 knees) who underwent TKA using antibiotic-loaded cement fixation. Fourteen patients had maintained hemodialysis and one patient had continuous ambulatory peritoneal dialysis. The function of the knee was evaluated before operation and postoperatively using Knee Society evaluating system. Postoperative complications and mortality were recorded for all patients. The average follow up period was 25 months (6 to 59 months).

RESULTS: There were no mortalities including short-term (≤90 days) or long-term (>90 days) follow up. The mean knee and function scores improved from preoperative 36 points (27~46) and 19.4 points (10~35) to 79 points (68~87) and 81 points (70~95) respectively at the latest follow up. One (6.7%) patient had early postoperative pneumonia (≤90 days). The late (>90 days) complication rate was 20% including 1 sepsis with toe gangrene, 1 recurrent stroke and 1 acute myocardiac infarction. There was no deep prosthetic joint infection or loosening of the components.

CONCLUSION: TKA with antibiotic-loaded cement resulted in a substantial low short-term mortality and deep infections in 15 patients with dialysis. However, a longer term follow up is necessary.