Abstract
Introduction: A hip replacement is an usually procedure in patients with chronic renal failure (CRF) affected of osteoarthritis, avascular necrosis of the femoral head or femoral neck fracture. The infection of the prosthesis is the most severe and important complication related to hip arthroplasty (HA). Patients with CRF have a immunosupression status, that increases the infection risk. The aim of the study was to evaluate the results of HA in patients on renal replacement therapy (RRT) through haemodialysis (HD) or renal transplantation (RT) .
Material and methods: Between 1990 and 2002, 23 HA have been performed in 18 patients on RRT (9 patients on HD and 9 RT). There were 9 women and 9 men, with an average age of 56 years old (range 30–83). In 5 patients the procedure was bilateral. The average time on RRT was 13.1 years (range 4–28). Preoperative diagnostic was: avascular necrosis of the femoral head (15 hips), femoral neck fracture (6 hips) and hip dysplasia (2 hips).
Results: The average follow-up was 59 months (range 3–140). All patients received antibiotic prophylaxis. Bleeding was the most frequent complication (74%, n=17). Infectious complications occurred in 33% of HA (n=6) in the early postoperative period and in 9% of HA (n=2) during the long-term follow-up. Early infections were: urinary tract infection (n=2 – Pseudomona species) and deep wound infection [n=4 – Pseudomona aeruginosa (n=1), Candida parapsilosis (n=1), Entero-coccus faecalis (n=1) and unknown aetiology (n=1), that required surgical debridement. Two patients had later infection of the prostheses (9%), and a two-stage revision in one case and resection arthroplasty in the other was performed. In-hospital mortality was 5.5% (n=1) and long-term mortality was 16.6% (n=3).
Conclusions: Infectious morbidity associated with HA in patients with chronic renal failure is important. The priority in this patients is individualize the surgical indication. An intensive medical control is needed.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
