Renal failure linked with higher PJI risk after TJA

Patients on dialysis who underwent elective total joint arthroplasty had a significantly higher incidence of in-hospital mortality.

Patients with end-stage renal failure who received hemodialysis had higher postoperative periprosthetic joint infection and in-hospital mortality rates after elective total joint arthroplasty, in a recent study.

“Patients with chronic renal failure are at a higher risk for complication, including infection and mortality,” Javad Parvizi, MD, FRCS, professor of orthopedic surgery at Sidney Kimmel School of Medicine, told Orthopedics Today.

To assess the risk of surgical site infection (SSI), periprosthetic joint infection (PJI) and in-hospital death related to chronic renal failure, Parvizi and his colleagues matched 359 patients with chronic renal failure who were undergoing total joint arthroplasty (TJA) with 718 controls by surgical procedure, gender, age, date of surgery and BMI.

Javad Parvizi

Javad Parvizi

Patients with chronic renal failure had a significantly higher Charlson comorbidity index compared with the control group (6.37 vs. 3.58). Researchers noted the incidence of all SSIs was 6.7% and 4.2% among patients with and without chronic renal failure, respectively. Of those SSIs, 3.3% and 2.2% were classified as PJIs among patients with and without chronic renal failure, respectively.

In addition, 20% of patients with end-stage renal disease who were undergoing hemodialysis developed a SSI, 8% of which were identified as a PJI compared with 4.5% in patients with chronic renal failure who did not receive hemodialysis. Patients with chronic renal failure also had a high incidence of in-hospital mortality that was significantly higher among patients receiving dialysis.

A multivariate analysis showed patients with chronic renal failure whose BMI was greater than 35 kg/m2, patients who were receiving hemodialysis and patients with a history of thromboembolic events had a significantly higher risk for developing infection. Researchers noted hemodialysis and a Charlson comorbidity index greater than 4.0 were significant risk factors for in-hospital mortality.

Parvizi noted strict protocols should be implemented that would require patients with chronic renal failure to see a nephrologist and have their condition optimized prior to surgery. He said orthopedists have moved toward the use of dual antibiotics in patients with chronic renal failure, as well as using other protocols to reduce infection.

“We have implemented a lot of interference to try to minimize the risk of infection, which includes ensuring that these patients have had skin cleansing by various agents. Intraoperatively, we administer blood conservation protocols. We aim to minimize the impact of anemia prior to surgery and multiple other steps,” Parvizi, an Orthopedics Today Editorial Board member, said. – by Casey Tingle

Disclosure: Parvizi reports he is a paid consultant to Zimmer Biomet, ConvaTec, TissueGene, CeramTec and Ethicon. He has stock options with Parvizi Surgical Innovations, Hip Innovation Technology, CD Diagnostics, CorenTec, Alphaeon, Joint Purification Systems, Ceribell, MedAp, MicroGenDx, Cross Current Business Intelligence, Invisible Sentinel, Physician Recommended Nutriceuticals and Intellijoint. He receives royalties from CorenTec, Datatrace, Elsevier, Jaypee, SLACK Incorporated and Wolters Kluwer.

Patients with end-stage renal failure who received hemodialysis had higher postoperative periprosthetic joint infection and in-hospital mortality rates after elective total joint arthroplasty, in a recent study.

“Patients with chronic renal failure are at a higher risk for complication, including infection and mortality,” Javad Parvizi, MD, FRCS, professor of orthopedic surgery at Sidney Kimmel School of Medicine, told Orthopedics Today.

To assess the risk of surgical site infection (SSI), periprosthetic joint infection (PJI) and in-hospital death related to chronic renal failure, Parvizi and his colleagues matched 359 patients with chronic renal failure who were undergoing total joint arthroplasty (TJA) with 718 controls by surgical procedure, gender, age, date of surgery and BMI.

Javad Parvizi

Javad Parvizi

Patients with chronic renal failure had a significantly higher Charlson comorbidity index compared with the control group (6.37 vs. 3.58). Researchers noted the incidence of all SSIs was 6.7% and 4.2% among patients with and without chronic renal failure, respectively. Of those SSIs, 3.3% and 2.2% were classified as PJIs among patients with and without chronic renal failure, respectively.

In addition, 20% of patients with end-stage renal disease who were undergoing hemodialysis developed a SSI, 8% of which were identified as a PJI compared with 4.5% in patients with chronic renal failure who did not receive hemodialysis. Patients with chronic renal failure also had a high incidence of in-hospital mortality that was significantly higher among patients receiving dialysis.

A multivariate analysis showed patients with chronic renal failure whose BMI was greater than 35 kg/m2, patients who were receiving hemodialysis and patients with a history of thromboembolic events had a significantly higher risk for developing infection. Researchers noted hemodialysis and a Charlson comorbidity index greater than 4.0 were significant risk factors for in-hospital mortality.

Parvizi noted strict protocols should be implemented that would require patients with chronic renal failure to see a nephrologist and have their condition optimized prior to surgery. He said orthopedists have moved toward the use of dual antibiotics in patients with chronic renal failure, as well as using other protocols to reduce infection.

“We have implemented a lot of interference to try to minimize the risk of infection, which includes ensuring that these patients have had skin cleansing by various agents. Intraoperatively, we administer blood conservation protocols. We aim to minimize the impact of anemia prior to surgery and multiple other steps,” Parvizi, an Orthopedics Today Editorial Board member, said. – by Casey Tingle

Disclosure: Parvizi reports he is a paid consultant to Zimmer Biomet, ConvaTec, TissueGene, CeramTec and Ethicon. He has stock options with Parvizi Surgical Innovations, Hip Innovation Technology, CD Diagnostics, CorenTec, Alphaeon, Joint Purification Systems, Ceribell, MedAp, MicroGenDx, Cross Current Business Intelligence, Invisible Sentinel, Physician Recommended Nutriceuticals and Intellijoint. He receives royalties from CorenTec, Datatrace, Elsevier, Jaypee, SLACK Incorporated and Wolters Kluwer.