Aims: To determine the rate of early and late infection amongst patients with renal disease undergoing TKA.

Methods and Materials: Review was undertaken of the Scottish National Arthroplasty Project data for the period from April 1985 to March 2008. Data was examined for the rate of infection amongst patients under-going TKA with a diagnosis of renal transplant, renal dialysis or renal failure. Early infection was classed as occurring within 90 days of the index procedure and late infection as occurring after 90 days. Renal failure, dialysis and transplant were identified using ICD 9 and 10 codes. The 4th revision of the OPCS codes was used to search for renal transplant, renal dialysis and knee arthroplasty.

Results: In total, 59288 TKAs were performed in Scotland over the period analysed. There were 651 early infections and 1296 late infections giving overall early and late infection rates of 1.1% and 2.2% respectively. 10 patients had renal transplant prior to TKA with 1 early infection (infection rate 1%) and no late infections. 44 patients had a renal transplant before or after TKA with 1 early and 6 late infections giving an early infection rate of 2.27% and late infection rate of 13.64% for this group. 17 patients undergoing renal dialysis underwent TKA with no early infections but a single late infection, giving a late infection rate of 5.8%. 2920 patients had a diagnosis of renal failure prior to or after TKA with 48 early and 138 late infections. Infection rates for this group were 1.64% early and 4.73% late.

Conclusions: TKA patients with renal transplant, renal failure or undergoing dialysis are at increased risk of infection. In particular, renal transplant patients are most at risk of late infection. Renal patients must be counselled of these increased risks prior to orthopaedic or transplant surgery.