Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review
Abstract Objectives End-stage renal disease (ESRD) patients are at an increased risk of needing total joint arthroplasty (TJA); however, both dialysis and renal transplantation might be potential predictors of adverse TJA outcomes. For dialysis patients, the high risk of blood-borne infection and im...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-020-02117-3 |
| _version_ | 1797999261987635200 |
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| author | Jiayi Li Mingyang Li Bo-qiang Peng Rong Luo Quan Chen Xin Huang |
| author_facet | Jiayi Li Mingyang Li Bo-qiang Peng Rong Luo Quan Chen Xin Huang |
| author_sort | Jiayi Li |
| collection | DOAJ |
| description | Abstract Objectives End-stage renal disease (ESRD) patients are at an increased risk of needing total joint arthroplasty (TJA); however, both dialysis and renal transplantation might be potential predictors of adverse TJA outcomes. For dialysis patients, the high risk of blood-borne infection and impaired muscular skeletal function are threats to implants’ survival, while for renal transplant patients, immunosuppression therapy is also a concern. There is still no high-level evidence in the published literature that has determined the best timing of TJA for ESRD patients. Methods A literature search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to November 2019) was performed to collect studies comparing TJA outcomes between renal transplant and dialysis patients. Two reviewers independently conducted literature screening and quality assessments with the Newcastle-Ottawa Scale (NOS). After the data were extracted, statistical analyses were performed. Results Compared with the dialysis group, a lower risk of mortality (RR = 0.56, Cl = [0.42, 0.73], P < 0.01, I 2 = 49%) and revision (RR = 0.42, CI = [0.30, 0.59], P < 0.01, I 2 = 43%) was detected in the renal transplant group. Different results of periprosthetic joint infection were shown in subgroups with different sample sizes. There was no significant difference in periprosthetic joint infection in the small-sample-size subgroup, while in the large-sample-size subgroup, renal transplant patients had significantly less risk (RR = 0.19, CI = [0.13, 0.23], P < 0.01, I 2 = 0%). For dislocation, venous thromboembolic disease, and overall complications, there was no significant difference between the two groups. Conclusion Total joint arthroplasty has better safety and outcomes in renal transplant patients than in dialysis patients. Therefore, delaying total joint arthroplasty in dialysis patients until renal transplantation has been performed would be a desirable option. The controversy among different studies might be partially accounted for that quite a few studies have a relatively small sample size to detect the difference between renal transplant patients and dialysis patients. |
| first_indexed | 2024-04-11T11:01:50Z |
| format | Article |
| id | doaj.art-5296d392067d43429896258f519e41e6 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T11:01:50Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-5296d392067d43429896258f519e41e62022-12-22T04:28:32ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-12-0115111010.1186/s13018-020-02117-3Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic reviewJiayi Li0Mingyang Li1Bo-qiang Peng2Rong Luo3Quan Chen4Xin Huang5Department of Nephrology, the People’s Hospital of Dazu, ChongqingDepartment of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Gastrointestinal Sursgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for BiotherapyDepartment of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Endocrinology, the People’s Hospital of Dazu, ChongqingAbstract Objectives End-stage renal disease (ESRD) patients are at an increased risk of needing total joint arthroplasty (TJA); however, both dialysis and renal transplantation might be potential predictors of adverse TJA outcomes. For dialysis patients, the high risk of blood-borne infection and impaired muscular skeletal function are threats to implants’ survival, while for renal transplant patients, immunosuppression therapy is also a concern. There is still no high-level evidence in the published literature that has determined the best timing of TJA for ESRD patients. Methods A literature search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to November 2019) was performed to collect studies comparing TJA outcomes between renal transplant and dialysis patients. Two reviewers independently conducted literature screening and quality assessments with the Newcastle-Ottawa Scale (NOS). After the data were extracted, statistical analyses were performed. Results Compared with the dialysis group, a lower risk of mortality (RR = 0.56, Cl = [0.42, 0.73], P < 0.01, I 2 = 49%) and revision (RR = 0.42, CI = [0.30, 0.59], P < 0.01, I 2 = 43%) was detected in the renal transplant group. Different results of periprosthetic joint infection were shown in subgroups with different sample sizes. There was no significant difference in periprosthetic joint infection in the small-sample-size subgroup, while in the large-sample-size subgroup, renal transplant patients had significantly less risk (RR = 0.19, CI = [0.13, 0.23], P < 0.01, I 2 = 0%). For dislocation, venous thromboembolic disease, and overall complications, there was no significant difference between the two groups. Conclusion Total joint arthroplasty has better safety and outcomes in renal transplant patients than in dialysis patients. Therefore, delaying total joint arthroplasty in dialysis patients until renal transplantation has been performed would be a desirable option. The controversy among different studies might be partially accounted for that quite a few studies have a relatively small sample size to detect the difference between renal transplant patients and dialysis patients.https://doi.org/10.1186/s13018-020-02117-3Total joint arthroplastyRenal transplantRenal dialysisOsteonecrosis of the femoral head |
| spellingShingle | Jiayi Li Mingyang Li Bo-qiang Peng Rong Luo Quan Chen Xin Huang Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review Journal of Orthopaedic Surgery and Research Total joint arthroplasty Renal transplant Renal dialysis Osteonecrosis of the femoral head |
| title | Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review |
| title_full | Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review |
| title_fullStr | Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review |
| title_full_unstemmed | Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review |
| title_short | Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review |
| title_sort | comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients a meta analysis and systematic review |
| topic | Total joint arthroplasty Renal transplant Renal dialysis Osteonecrosis of the femoral head |
| url | https://doi.org/10.1186/s13018-020-02117-3 |
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