Influence of Chronic Kidney Disease on Patients Undergoing Elective Hip and Knee Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Background: The increasing prevalence of chronic kidney disease (CKD) in recent years and its impact on renal dysfunction on orthopedic surgery continues to draw more attention to orthopedic surgeons. The purpose of this study is to investigate the influence of CKD on comorbidities and complications in patients who underwent elective low limbs surgery. Material and Methods: Until August 2018, Pubmed, Embase, Cochrane library, and Web of science were used to search relevant literature. After reviewing the article title, the abstract, and the full text, a total of 11 articles were identified in the qualitative synthesis. Demographic data, comorbidities, and complications were assessed between CKD and non-CKD patients. Review Manager 5.3 was used for the statistical analysis, and forest plots were constructed for each variable. Results: A total of 137,436 patients (10,732 patients with CKD and 126,704 patients without CKD) from 11 studies were enrolled in this meta-analysis. CKD patients showed worse health conditions in comparison to non-CKD patients. The incidence of several preoperative comorbidities (hypertension, diabetes, and cardiac-cerebral disease) and postoperative complications (infection, transfusion, deep vein thrombosis, and early mortality) were higher in CKD patients. Conclusions: In elective hip and knee surgery, compared with non-CKD patients, CKD patients showed worse health conditions. Due to a higher rate of comorbidities and complications in CKD patients, they should be treated carefully during perioperative periods.

Prevalence and risk factors for perioperative complications of CKD patients undergoing elective hip surgery.

PURPOSE: Chronic kidney disease (CKD) is known to increase morbidity and mortality after orthopedic surgery. The purpose of this study is to investigate how CKD affects perioperative complications in hip surgery patients. MATERIAL AND METHODS: From 2013 to 2016, a total of 230 patients (30 patients with CKD and 200 without CKD) undergoing hip surgery were enrolled in this study. Preoperative, intraoperative, and postoperative data was collected and analyzed between CKD and non-CKD patients. Logistic regression was used to evaluate the independent risk factor for postoperative complications. RESULTS: There were significant differences in the number of people with hypertension (90.0% vs 27.3%, P < 0.001), diabetes (33.3% vs 8.7%, P = 0.01), coronary heart disease (20.0% vs 2.0%, P = 0.001), smoking habits (56.7% vs 22.7%, P = 0.016), anemia (90.0% vs 19.3%, P < 0.001), and low hemoglobin levels (94.1 ± 19.7 vs 121.3 ± 18.8, P < 0.001) between CKD and non-CKD patients before surgery. Receiving a blood transfusion was significantly more common in CKD patients (50% vs 28.5%, P = 0.018). Postoperatively, significant differences were detected in the average number of patients who transferred to the ICU (73.3% vs 19.3%, P < 0.001). Furthermore, differences were found in the quantity of hemoglobin (92.5 ± 16.8 vs 107.5 ± 18.3, P < 0.001) and albumin (32.4 ± 4.1 vs 34.9 ± 5.5, P = 0.02) measured between CKD and non-CKD patients. Logistic regression analysis indicated that diabetes, alcohol, and anemia were all independent risk factors for obtaining a blood transfusion, while age, CKD, and osteoporosis were all independent risk factors for ICU transfers. CONCLUSION: Compared with non-CKD patients, CKD patients were accompanied with more cardiac diseases preoperatively. In addition, CKD patients were more likely to receive a blood transfusion and transfer to the ICU after hip surgery. Preoperative anemia should be restored sufficiently to decrease the incidence of blood transfusions.

Distribution Pattern Making Sense: Patients Achieve Rapider Pain Relief with Confluent Rather Than Separated Bilateral Cement in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures.

BACKGROUND: It has been reported the distribution of bone cement in percutaneous kyphoplasty (PKP) has an impact on the curative effect. No studies have compared between confluent and separated cement pattern of bilateral bone cement in PKP for patients with osteoporotic vertebral compression fractures. METHODS: Between 2010 and 2016, 1341 patients were enrolled and divided into 2 groups. Group A (n = 723), bilateral cement was confluent; Group B (n = 618), bilateral cement was separated. The visual analogue scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), and local kyphotic angle (LKA) were obtained preoperatively, 2 days after surgery, and at the final follow-up to assess the functional and radiographic efficacy of the surgery. RESULTS: The VAS, ODI, AVH, and LKA 2 days after operation and at the final follow-up were significantly improved compared with the preoperative for both groups (P < 0.05). There existed no significant difference between groups at various time point in ODI, AVH, and LKA (P > 0.05). Group A showed better VAS than group B 2 days after surgery (1.91 ± 0.98 vs. 2.35 ± 0.78, P < 0.001), also with better pre-postoperative VAS change (6.23 ± 0.76 vs. 5.75 ± 1.02, P < 0.001). Multiple linear regression for pain relief degree revealed group A (P < 0.001), older age (P < 0.001), and more cement volume (P < 0.001) contribute to rapid improvement of back pain. The cement leakage rate was 3.7% in group A and 2.9% in group B, with no significant difference (P = 0.405). CONCLUSIONS: Patients achieved rapider pain relief with confluent rather than separated bilateral bone cement pattern in PKP for osteoporotic vertebral compression fracture.

Comparative Study Between Anterior Cervical Discectomy and Fusion with ROI-C Cage and Laminoplasty for Multilevel Cervical Spondylotic Myelopathy without Spinal Stenosis.

BACKGROUND: Selection of anterior versus posterior surgery for multilevel (≥3) cervical spondylotic myelopathy (MCSM) continues to be controversial. A comparison between anterior cervical discectomy and fusion (ACDF) with ROI-C cage and laminoplasty was made to determine the better treatment for MCSM. METHODS: Between 2012 and 2017, 57 patients received either ACDF with ROI-C or laminoplasty (LMP) treatment. Clinical and radiologic outcomes between the 2 groups were compared. RESULTS: In total, 24 patients underwent ACDF with ROI-C cage (ACDF group) and 33 patients underwent LMP (LMP group). They were studied with a median follow-up of 22 months. Less operative blood loss (136.7 ± 60.8 vs. 316.7 ± 139.6 mL, P < 0.001) and a shorter hospital stay (7.8 ± 1.6 vs. 9.9 ± 3.3 days, P < 0.01) were notable for ACDF. The Japanese Orthopedic Association score showed that ACDF and LMP improved similarly (recovery rate, 55.3 ± 19.2% vs. 58.9 ± 18.1%, P > 0.05). Preoperative occupying rate and JOA score significantly affected the operation result (P < 0.01). The cervical lordosis, segmental cervical lordosis, and T1 slope were all larger in the ACDF group. The cervical range of motion decreased 10.6° in the ACDF group and 4.8° in the LMP group (P = 0.01). No significant differences were found between complication rates. CONCLUSIONS: ACDF with ROI-C cage has a similar clinical efficacy to LMP for patients with MCSM. There was less blood loss, shorter hospital stays, and improved sagittal balance when ACDF was used. However, a greater decrease in range of motion was observed after ACDF. Preoperative occupying ratio and Japanese Orthopaedic Association score are potential risk factors for different outcomes.