Around three million people in the UK have Chronic Kidney Disease (CKD) and around 63,000 are being treated for kidney failure.
What is Chronic Kidney Disease (CKD)?
CKD refers to a range of conditions that damage the kidneys and can lead to complications like anaemia, high blood pressure and weak bones. CKD also increases the risk of diseases that affect the heart and blood vessels. CKD is categorised in five stages relating to how effectively your kidneys work to filter waste and extra fluid from your blood. In the early stages, the kidneys are still able to filter waste from your blood but once the condition is at stages 4 and 5, your kidney function is severely compromised and may stop working altogether.
Impact of CKD on joint replacement surgery
If you have CKD and are due to undergo a total hip or knee replacement, your consultant will discuss the risk of developing post-surgical complications, including prosthetic joint infection which could lead to the need for further surgery (revision joint replacement). The risk of developing periprosthetic joint infection is affected by a range of factors including the health of the patient. For this reason, chronic diseases like CKD are a concern for us as orthopaedic surgeons and we will discuss ways to reduce your risks prior to your procedure.
Study in The Bone and Joint Journal
A recent study published in The Bone and Joint Journal set out to investigate whether CKD is linked to an increased risk of joint replacement revision surgery, and specifically revision surgery due to the development of an infection in the prosthetic implant.
Methodology
Researchers looked at 18,979 total hip and knee replacements that had been performed at a major academic teaching hospital. They assessed all revision surgery that had taken place eight years after the primary joint replacement procedures, as well as any patient deaths over the same period.
Findings
A total of 11.1% of patients (2,111) had died and 3.6% (677) had received revision surgery. In 162 cases, revision joint replacement surgery was necessary due to periprosthetic joint infection. For patients who underwent a hip replacement, 3.5% had CKD stage 1, 3.8% stage 2, 4.2% stage 3 and 0% with stages 4 and 5. For patients receiving a total knee replacement, 4.7% had normal kidney function, 2.7% had CKD stage 2, 2.4% stage 3 and 7% with stages 4 and 5.
Researchers concluded that there was no strong evidence to suggest that a patient with Chronic Kidney Disease is at greater risk of needing revision joint replacement surgery than someone with normal kidney function. They believe that selection bias probably explains the increased rate of joint revision surgery in patients with normal kidney function who underwent knee replacement surgery. As there was a very small number of patients with CKD stage 4 and 5, the impact on joint revision surgery was hard to evaluate.
Study in Knee Surgery & Related Research
A previous study, published in February 2020 in Knee Surgery & Related Research, compared revision rates after total joint replacement surgery between patients with normal kidney function and patients with chronic kidney disease. Researchers looked at 18 studies on MEDLINE, EMBASE and the Cochrane Library.
In this case, researchers found that the number and severity of preoperative comorbidities were higher in CKD patients than patients without CKD. The risk of mortality was higher in CKD and dialysis patients compared to control groups. However rates of revision surgery did not differ significantly between CKD and non-CKD patients although after a total hip replacement, the risk of periprosthetic joint infection was higher in patients receiving dialysis than those who weren’t. There was no significant difference following a total knee replacement.
Improving the chances of positive outcomes
Although both studies failed to show that CKD is associated with an increased risk of revision joint replacement surgery due to implant infection nevertheless, it is important to discuss any chronic health conditions like CKD with your orthopaedic surgeon before joint replacement surgery. Joseph Queally carries out a detailed risk stratification and will discuss measures to optimise your health prior to surgery to improve the chances of positive outcomes.
If you have CKD and are concerned about undergoing a total knee or hip replacement, contact us for advice.
