Abstract
Introduction
Dialysis has been associated with increased complication rates following total knee arthroplasty (TKA). However, the current literature on this topic is limited and does not distinguish between hemodialysis (HD) and peritoneal dialysis (PD). It is unknown if the type of dialysis influences the risks of adverse outcome. The purpose of this study was to determine if infection and complication rates after TKA differ based on the mode of dialysis.
Methods
Patients undergoing primary TKA from 2005 to 2014 were identified in the Medicare database. Patients with PD were matched 1:1 to patients with HD and 1:3 with patients who were not receiving either form of dialysis. Multivariate regression analysis was performed to examine several adverse events including the incidence of infection at 1 year and readmission to the hospital at 30 days.
Results
PD was identified in 531 patients undergoing TKA. Infection rates were significantly lower in patients receiving PD compared to HD (3.39% versus 6.03%; p=0.026; odds ratio, 0.67; 95% CI 0.49 – 0.93). PD appeared to result in a similar infection rates when compared to matched controls who were not receiving dialysis. Other assessed outcomes (mortality rates, emergency room visits, hospital readmission rates) were very similar between PD and HD but noted to all be significantly higher than non-dialysis dependent controls.
Discussion and Conclusions
The increased risk of complications in dialysis-dependent patients following TKA depends upon the type of dialysis. Whereas patients with HD have a significantly higher risk of infection, patients with PD do not appear to have this same risk when compared to non-dialysis dependent patients. To our knowledge, this is the only study to date to distinguish patients by the type of dialysis and suggests the type of dialysis should be used to assess risk when considering TKA.
