Peri-prosthetic fracture after joint replacement in the lower limb is associated with significant morbidity. The primary aim of this study was to investigate the incidence of peri-prosthetic fracture after total hip replacement (THR) and total knee replacement (TKR) over a ten-year period using a population-based linked dataset.

Between 1 April 1997 and 31 March 2008, 52 136 primary THRs, 8726 revision THRs, 44 511 primary TKRs, and 3222 revision TKRs were performed. Five years post-operatively, the rate of fracture was 0.9% after primary THR, 4.2% after revision THR, 0.6% after primary TKR and 1.7% after revision TKR. Comparison of survival analysis for all primary and revision arthroplasties showed peri-prosthetic fractures were more likely in females, patients aged > 70 and after revision arthroplasty.

Female patients aged > 70 should be warned of a significantly increased risk of peri-prosthetic fracture after hip or knee replacement. The use of adjuvant medical treatment to reduce the effect of peri-prosthetic osteoporosis may be a direction of research for these patients.

We undertook a study to determine the rates of infection and revision of total knee replacement (TKR) in patients with renal failure, renal transplantation and those undergoing renal dialysis in Scotland. The overall early and late infection rates were 1.10% and 2.19% compared with 1.06% and 2.01%, respectively, for non-renal patients. Patients with renal failure had a significantly increased risk of early infection (1.6%, relative risk 1.52, p = 0.002) and late infection (4.47%, relative risk 2.22, p < 0.001). Those on renal dialysis had significantly increased risks of late infection (8.03%, relative risk 3.99, p < 0.001) and early revision (3.70%, relative risk 4.40, p < 0.001). Renal transplant patients had a significantly increased risk of late infection, regardless of whether renal transplantation occurred before TKR (9.09%, relative risk 4.517, p = 0.027) or at any time (8.0%, relative risk 3.975, p = 0.047). There were significantly increased rates of comorbidities associated with infection for all the renal patient groups. Logistic regression analysis showed that renal failure and renal dialysis were independent risk factors for early infection and revision, respectively.

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.