Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-01-2021 | Chronic Kidney Disease | Original Article

Preoperative estimated glomerular filtration rate is a marker for postoperative complications following aseptic revision total hip arthroplasty

Authors: Aaron Z. Chen, Alex Gu, Nicolas A. Selemon, Jordan S. Cohen, Chapman Wei, Haley Tornberg, Marc D. Chodos, Joshua Campbell, Peter K. Sculco

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 1/2021

Abstract

Introduction

Revision total hip arthroplasty (rTHA) is increasingly performed but may carry a high rate of complication. This aim of the study was to determine if a decreased eGFR increases risks of postoperative complications following rTHA.

Methods

A retrospective cohort study using the American College of Surgeons National Quality Improvement Program Database was conducted. Patients undergoing rTHA between 2007 and 2014 were identified and stratified by glomerular filtration rates (eGFR): eGFR > 125 mL/min, eGFR 90–125 mL/min, eGFR 60–90 mL/min, eGFR 30–60 mL/min, and eGFR < 30 mL/min. The incidence of postoperative adverse events within 30 days, including cardiac, pulmonary, renal, septic, thromboembolic, urinary tract, and wound complications, blood transfusion, death, length of stay > 7 days, and unplanned return to the operating room, was assessed. The complication rates following rTHA were assessed with univariate and multivariate analysis with a significance set at p < 0.05.

Results

In total, 8898 revision THA procedures were included for analysis. 28.4% of patients that underwent rTHA developed a complication following surgery. Following adjustment, an eGFR of less than 30 mL/min independently increased the odds of any complication (OR 1.447; 95% C.I. 1.010–2.074; p = 0.044), cardiac complications (OR 3.344; 95% C.I. 1.040–10.752; p = 0.043), blood transfusion (O.R. 1.623; 95% C.I. 1.122–2.352; p = 0.010), and extended length of stay (O.R. 2.392; 95% C.I. 1.526–3.759; p < 0.001) when compared to normal renal function.

Conclusions

Diminished eGFR of less than 30 mL/min increased the odds of total complications, cardiac complications, blood transfusions, and extended length of stay compared to normal renal function.

Alzahrani MM, Smith K, Tanzer D, Tanzer M (2016) Primary total hip arthroplasty: equivalent outcomes in low and high functioning patients. J Am Acad Orthop Surg 24(11):814–822. https://doi.org/10.5435/JAAOS-D-16-00361CrossRefPubMed

Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370(9597):1508–1519. https://doi.org/10.1016/S0140-6736(07)60457-7CrossRefPubMed

Bayliss LE, Culliford D, Monk AP, Glyn-Jones S, Prieto-Alhambra D, Judge A, Cooper C, Carr AJ, Arden NK, Beard DJ, Price AJ (2017) The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 389(10077):1424–1430. https://doi.org/10.1016/S0140-6736(17)30059-4CrossRefPubMedPubMedCentral

Hailer NP, Garellick G, Karrholm J (2010) Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Acta Orthop 81(1):34–41. https://doi.org/10.3109/17453671003685400CrossRefPubMedPubMedCentral

Bozic KJ, Kamath AF, Ong K, Lau E, Kurtz S, Chan V, Vail TP, Rubash H, Berry DJ (2015) Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 473(6):2131–2138. https://doi.org/10.1007/s11999-014-4078-8CrossRefPubMed

Clohisy JC, Calvert G, Tull F, McDonald D, Maloney WJ (2004) Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res 429:188–192. https://doi.org/10.1097/01.blo.0000150126.73024.42CrossRef

Haynes JA, Stambough JB, Sassoon AA, Johnson SR, Clohisy JC, Nunley RM (2016) Contemporary surgical indications and referral trends in revision total hip arthroplasty: a 10-year review. J Arthroplasty 31(3):622–625. https://doi.org/10.1016/j.arth.2015.09.026CrossRefPubMed

Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: What are the reasons for revision? Int Orthop 32(5):597–604. https://doi.org/10.1007/s00264-007-0364-3CrossRefPubMed

Isaacson MJ, Bunn KJ, Noble PC, Ismaily SK, Incavo SJ (2016) Quantifying and predicting surgeon work input in primary versus revision total hip arthroplasty. J Arthroplasty 31(6):1188–1193. https://doi.org/10.1016/j.arth.2015.11.042CrossRefPubMed

10.

Schwartz BE, Piponov HI, Helder CW, Mayers WF, Gonzalez MH (2016) Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop 40(9):1793–1802. https://doi.org/10.1007/s00264-016-3121-7CrossRefPubMed

11.

Badarudeen S, Shu AC, Ong KL, Baykal D, Lau E, Malkani AL (2017) Complications after revision total hip arthroplasty in the medicare population. J Arthroplasty 32(6):1954–1958. https://doi.org/10.1016/j.arth.2017.01.037CrossRefPubMed

12.

Kuo FC, Lin PC, Lu YD, Lee MS, Wang JW (2017) Chronic kidney disease is an independent risk factor for transfusion, cardiovascular complication, and thirty-day readmission in minimally invasive total knee arthroplasty. J Arthroplasty 32(5):1630–1634. https://doi.org/10.1016/j.arth.2016.12.006CrossRefPubMed

13.

Miric A, Inacio MC, Namba RS (2014) The effect of chronic kidney disease on total hip arthroplasty. J Arthroplasty 29(6):1225–1230. https://doi.org/10.1016/j.arth.2013.12.031CrossRefPubMed

14.

Warren JA, George J, Anis HK, Krebs OK, Molloy RM, Higuera CA, Piuzzi NS (2020) Effects of estimated glomerular filtration rate on 30-day mortality and postoperative complications after total hip arthroplasty: a risk stratification instrument. J Arthroplasty 35(3):786–793. https://doi.org/10.1016/j.arth.2019.10.001CrossRefPubMed

15.

Bovonratwet P, Malpani R, Ottesen TD, Tyagi V, Ondeck NT, Rubin LE, Grauer JN (2018) Aseptic revision total hip arthroplasty in the elderly: quantifying the risks for patients over 80 years old. Bone Joint J 100-B(2):143–151. https://doi.org/10.1302/0301-620x.100b2.bjj-2017-0895.r1CrossRefPubMed

16.

Tornero E, Garcia-Oltra E, Garcia-Ramiro S, Martinez-Pastor JC, Bosch J, Climent C, Morata L, Camacho P, Mensa J, Soriano A (2012) Prosthetic joint infections due to Staphylococcus aureus and coagulase-negative staphylococci. Int J Artif Organs 35(10):884–892. https://doi.org/10.5301/ijao.5000148CrossRefPubMed

17.

Trickey AW, Wright JM, Donovan J, Reines HD, Dort JM, Prentice HA, Graling PR, Moynihan JJ (2017) Interrater reliability of hospital readmission evaluations for surgical patients. Am J Med Qual 32(2):201–207. https://doi.org/10.1177/1062860615623854CrossRefPubMed

18.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006CrossRefPubMedPubMedCentral

19.

Lie SA, Havelin LI, Furnes ON, Engesaeter LB, Vollset SE (2004) Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register. J Bone Joint Surg Br 86(4):504–509CrossRefPubMed

20.

Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA (2003) Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am 85(1):27–32. https://doi.org/10.2106/00004623-200301000-00005CrossRefPubMed

21.

Bedard NA, Dowdle SB, Owens JM, Duchman KR, Gao Y, Callaghan JJ (2018) What is the impact of smoking on revision total hip arthroplasty? J Arthroplasty 33(7S):S182–S185. https://doi.org/10.1016/j.arth.2017.12.041CrossRefPubMed

22.

Gu A, Chen FR, Chen AZ, Fassihi SC, Thakkar S, Unger AS, Liu J, Sculco PK, Ast MP (2020) Preoperative hyponatremia is an independent risk factor for postoperative complications in aseptic revision hip and knee arthroplasty. J Orthop 20:224–227. https://doi.org/10.1016/j.jor.2020.01.028CrossRefPubMedPubMedCentral

23.

Lakomkin N, Goz V, Lajam CM, Iorio R, Bosco JA 3rd (2017) Higher modified Charlson Index scores are associated with increased incidence of complications, transfusion events, and length of stay following revision hip arthroplasty. J Arthroplasty 32(4):1121–1124. https://doi.org/10.1016/j.arth.2016.11.014CrossRefPubMed

24.

Liodakis E, Bergeron SG, Zukor DJ, Huk OL, Epure LM, Antoniou J (2015) Perioperative complications and length of stay after revision total hip and knee arthroplasties: an analysis of the NSQIP database. J Arthroplasty 30(11):1868–1871. https://doi.org/10.1016/j.arth.2015.05.029CrossRefPubMed

25.

Rynecki ND, Congiusta DV, Fields M, Patel R, Vosbikian MM, Ahmed IH (2020) Increased risk of complications in patients with hypoalbuminemia undergoing revision total hip arthroplasty. J Orthop 21:253–257. https://doi.org/10.1016/j.jor.2020.03.006CrossRefPubMedPubMedCentral

26.

Jamsa PP, Oksala NKJ, Eskelinen AP, Jamsen ER (2018) Chronic kidney diseases among patients undergoing elective arthroplasty: risk groups and the value of serum creatinine. J Arthroplasty 33(1):230–234 e231. https://doi.org/10.1016/j.arth.2017.07.050

27.

Krebs OK, Warren JA, Anis HK, George J, McLaughlin J, Molloy RM, Krebs VE, Piuzzi NS (2020) Estimated glomerular filtration rate as a risk stratification tool for early complications in revision total hip and knee arthroplasty. J Arthroplasty 35(5):1315–1322. https://doi.org/10.1016/j.arth.2019.12.007CrossRefPubMed

28.

George J, Chughtai M, Khlopas A, Klika AK, Barsoum WK, Higuera CA, Mont MA (2018) Readmission, reoperation, and complications: total hip versus total knee arthroplasty. J Arthroplasty 33(3):655–660. https://doi.org/10.1016/j.arth.2017.09.048CrossRefPubMed

29.

Ackland GL, Moran N, Cone S, Grocott MP, Mythen MG (2011) Chronic kidney disease and postoperative morbidity after elective orthopedic surgery. Anesth Analg 112(6):1375–1381. https://doi.org/10.1213/ANE.0b013e3181ee8456CrossRefPubMed

30.

Cohen JS, Gu A, Wei C, Sobrio SA, Liu J, Abdel MP, Sculco PK (2019) Preoperative estimated glomerular filtration rate is a marker for postoperative complications following revision total knee arthroplasty. J Arthroplasty 34(4):750–754. https://doi.org/10.1016/j.arth.2018.12.005CrossRefPubMed

31.

Lejus C, Desdoits A, Lambert C, Langlois C, Roquilly A, Gouin F, Asehnoune K (2012) Preoperative moderate renal impairment is an independent risk factor of transfusion in elderly patients undergoing hip fracture surgery and receiving low-molecular-weight heparin for thromboprophylaxis. J Clin Anesth 24(5):378–384. https://doi.org/10.1016/j.jclinane.2011.10.015CrossRefPubMed

Title: Preoperative estimated glomerular filtration rate is a marker for postoperative complications following aseptic revision total hip arthroplasty
Authors: Aaron Z. Chen
Alex Gu
Nicolas A. Selemon
Jordan S. Cohen
Chapman Wei
Haley Tornberg
Marc D. Chodos
Joshua Campbell
Peter K. Sculco
Publication date: 01-01-2021
Publisher: Springer Paris
Keywords: Chronic Kidney Disease
Hip-TEP
Hip-TEP
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 1/2021
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-020-02761-9

At a glance: The STEP trials

Springer Medicine

Preoperative estimated glomerular filtration rate is a marker for postoperative complications following aseptic revision total hip arthroplasty

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

The inverted Vancouver C fracture. Case series of unstable proximal femur fractures above a knee revision stem treated by short cephalomedullary nail and lateral submuscular overlapping plate

Early outcomes of magnetic intramedullary compression nailing for humeral fractures

Diagnostic performance of suction drainage fluid culture for acute surgical site infection after aseptic instrumented spine surgery: a retrospective analysis of 363 cases

Treatment and re-operation rates in one thousand and three hundred tibial fractures from the Swedish Fracture Register

Feasibility of pre- and postoperative arthroscopic assessments with internal fixation for growth plate injury of the distal tibia: three case reports and a literature review

Injury and treatment patterns of ballistic pelvic fractures by anatomic location