Joint arthroplasty in patients treated with chronic dialysis. Results of a single center study and review

Background: rapid growth of patient’s population with chronic kidney disease stage 5, who are under the increased risk of bone damage due to mineral bone disease, increases the need for endoprosthetics in this population with high comorbidity. The study was focused on the practical application of endoprosthesis of large joints in dialysis patients. Aim: to evaluate efficacy and safety of total hip and knee joint arthroplasty in patients treated with chronic dialysis and to develop practical approach for the perioperative patient management considering concomitant bone and other disorders. Materials and methods: 25 patients treated with chronic dialysis (23 program hemodialysis, 2 peritoneal dialysis) were under our observation with median duration of RRT 74 months. We performed 34 operations: 28 total hip arthroplasty (THA), 5 total knee arthroplasty (TKA), 1 revision knee arthroplasty (RKA). We used endoprosthesis with different types of fixation and friction pair. All patients had signs and features of mineral bone disease and impaired mineral metabolism. In case of pronounced bone demineralization (Z score less than -3,5), the operation was postponed until improvement with alphacalcidol treatment. Other specific issue of patient’s management was prophylaxis of thrombotic complications using direct anticoagulants and antibiotic prophylaxis of a surgical infection. Operations were performed between two dialysis days. Results: good efficacy of hip and knee arthroplasty was demonstrated using multidisciplinary approach in a big hospital, with a low incidence of complications in ESRD patients with mineral bone disease. Three cases of thrombosis of the lower extremities, 1 periprosthetic fracture, 1 suppuration of the endoprosthesis were referred as the early complications of 34 surgical interventions. There were no cases of disturbance of dialysis mode and efficacy. Subsequent follow-up with median duration of 23 months showed improvement in the functional parameters of the joints and the absence of the need for revisions in the long-term period. Conclusions: patients with chronic kidney disease stage 5, receiving treatment with programmed dialysis, who need total arthroplasty can be effectively managed in the multidisciplinary hospitals with preliminary correction of bone and mineral disorders and adequate anticoagulant and antimicrobial prophylaxis.

гемодиализ, минерально-костные нарушения, тотальное эндопротезирование, hemodialysis, renal osteodistrophy, total arthroplasty

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