Total Hip Arthroplasty Outcomes before or after Renal Transplant: A Retrospective Large Cohort Analysis.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-06-01 Epub Date: 2024-04-22 DOI:10.4055/cios23351

Zhichang Zhang, Elizabeth Driskill, Jialun Chi, Richard P Gean, Quanjun Cui

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引用次数: 0

Abstract

Background: While it is known that patients with end-stage renal disease (ESRD) are at an increased risk of complications following total hip arthroplasty (THA), there is a gap in the literature in comparing patients with ESRD to patients who undergo renal transplant (RT) before or after THA. This study is to address this gap by analyzing outcomes of THA in ESRD patients, RT patients, and RT candidates.

Methods: Using the PearlDiver Mariner database, ESRD patients, RT patients, and RT candidates undergoing primary THA were identified and compared. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. Ninety-day emergency department (ED) visits and inpatient readmission were also documented.

Results: A total of 7,868 patients were included: 5,092 had ESRD, 2,520 had RT before THA, and 256 were candidates for RT. Compared to patients with ESRD, RT patients demonstrated lower rates of medical complications such as pneumonia (3.61% vs. 5.99%, p = 0.039) and transfusion (4.60% vs. 7.66%, p < 0.001). Additionally, RT patients displayed decreased rates of surgical complications, including wound complications (2.70% vs. 4.22%, p = 0.001), periprosthetic joint infection (PJI) at 1 year (2.30% vs. 4.81%, p < 0.001) and 2 years (2.58% vs. 5.42%, p < 0.001), and aseptic loosening at 2 years (0.79% vs. 1.43%, p = 0.006). Similarly, when compared to RT candidates, RT patients demonstrated a lower incidence of postoperative complications, including 1-year PJI (2.30% vs. 5.08%, p = 0.013), 2-year PJI (2.58% vs. 5.08%, p = 0.028), 1-year aseptic loosening (0.56% vs. 2.73%, p < 0.001), and 2-year aseptic loosening (0.79% vs. 2.73%, p = 0.005). RT patients also had lower rates of ED visits and hospital readmissions.

Conclusions: Compared to ESRD patients and RT candidates, patients with RT have a significantly lower likelihood of medical complications, PJI, aseptic hardware loosening, ED visits, and hospital readmission. Patients with ESRD on the RT waiting list should delay THA until after RT surgery. For those not eligible for RT, it is vital to take extra precautions to reduce the risk of complications.

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肾移植前后的全髋关节置换术结果：回顾性大型队列分析。

背景：众所周知，终末期肾病（ESRD）患者在接受全髋关节置换术（THA）后发生并发症的风险会增加，但在将 ESRD 患者与在接受全髋关节置换术（THA）前后接受肾移植（RT）的患者进行比较方面还存在文献空白。本研究通过分析 ESRD 患者、RT 患者和 RT 候选者的 THA 结果来填补这一空白：方法：使用 PearlDiver Mariner 数据库，对接受初次 THA 的 ESRD 患者、RT 患者和 RT 候选者进行识别和比较。对90天内的内科并发症和2年内的外科并发症进行了多变量逻辑回归分析。此外，还记录了90天内的急诊就诊率和住院再入院率：共纳入 7868 名患者：结果：共纳入 7,868 名患者：5,092 人患有 ESRD，2,520 人在 THA 之前接受过 RT，256 人是 RT 候选者。与 ESRD 患者相比，RT 患者的并发症发生率较低，如肺炎（3.61% 对 5.99%，P = 0.039）和输血（4.60% 对 7.66%，P < 0.001）。此外，RT 患者的手术并发症发生率也有所下降，包括伤口并发症（2.70% 对 4.22%，P = 0.001）、1 年（2.30% 对 4.81%，P < 0.001）和 2 年（2.58% 对 5.42%，P < 0.001）的假体周围关节感染（PJI）以及 2 年的无菌性松动（0.79% 对 1.43%，P = 0.006）。同样，与 RT 候选者相比，RT 患者的术后并发症发生率较低，包括 1 年 PJI（2.30% 对 5.08%，P = 0.013）、2 年 PJI（2.58% vs. 5.08%，p = 0.028）、1 年无菌性松动（0.56% vs. 2.73%，p < 0.001）和 2 年无菌性松动（0.79% vs. 2.73%，p = 0.005）。RT患者的急诊就诊率和再住院率也较低：结论：与 ESRD 患者和 RT 候选者相比，接受 RT 治疗的患者发生医疗并发症、PJI、无菌性硬件松动、急诊就诊和再次入院的可能性明显较低。等待接受 RT 的 ESRD 患者应将 THA 推迟到 RT 手术之后。对于不符合 RT 条件的患者，采取额外的预防措施以降低并发症风险至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.