Features of diagnosis of osteo-articular pathology in total hip and knee arthroplasty in patients with end stage renal disease

The objective was the objective assessment of the main osteo-specific laboratory and instrumental diagnostic indicators and their prognostic effect on the outcome of surgical treatment.

Material and methods. The study included 72 patients who were divided into 2 groups: 35 (48.6 %) patients with a satisfactory outcome after surgery for year, and 37 (51.4 %) patients with various postoperative complications.

Results. The highest statistical significance was indicated by the level of serum vitamin D (p<0.001) and the level of fibrinogen (p<0.001). The average value of the Hounsfield index in the group of patients without complications was 164.5 (Me 51.2), in the group of patients with complications – 71.5 (Me 85.0). The statistical significance (p<0.001) of the Hounsfield index between the two groups of patients was noted. The highest statistical significance was indicated by the level of serum vitamin D (p<0.001) and the level of fibrinogen (p<0.001). A discriminant analysis was performed with the construction of canonical correlation based on the results of laboratory and instrumental indices in order to determine the relationship between the obtained parameters and infectious and common complications.

Conclusion. The discriminant prediction formula for infectious complications among patients planned for hip / knee arthroplasty obtained during the study had a high sensitivity (90 %) and specificity (87.1 %).

1. Zemchenkov A. Yu., Konakova I. N. Tempy progressirovaniya khronicheskoi bolezni pochek po dannym SanktPeterburgskogo gorodskogo registra KhBP. Nefrologiya i dializ. 2013;17(1):34–51. (In Russ.).

2. Torres A., García S., Gómez A. et al. Treatment with intermittent calcitriol and calcium reduces bone loss after renal transplantation. Kidney Int. 2004;2(65):705–712. Doi: 10.1111/j.1523-1755.2004.00432.x.

3. Neverov V. A., Salman Raed. Osobennosti gemodializnykh bol’nyh i recipientov allogennnoi pochki, opredelyayushchie trebovaniya k operacii ekhndoprotezirovaniya tazobedrennogo sustava. Vestnik khirurgii im. I. I. Grekova. 2005;(4):58–62. (In Russ.).

4. West S. L., Patel P., Jamal S. A. How to predict and treat increased fracture risk in chronic kidney disease. J Intern Med. 2015;278(1):19–28. Doi: https://doi.org/10.1111/joim.12361.

5. Naylor K., Prior J., Garg A., Berger C., Langsetmo L., Adachi J. Trabecular bone score and incident fragility fracture risk in adults with reduced kidney function. Clin J Am Soc Nephrol. 2016;11(11):2032–2040.

6. Figurek A., Vlatkovic V., Vojvodic D., Gasic B., Grujicic M. The frequency of bone fractures among patients with chronic kidney disease not on dialysis: two-year follow-up. Rom J Intern Med. 2017;55(4):222–228. Doi: https://doi.org;/10.1515/rjim-2017-0021.

7. Tsukamoto Y. Is it possible to-predict fracture in CKD patients? Clin Calcium. 2016;26(9):1295–1300.

8. Chen H., Chiu Y., Hsu S. Relationship between fetuinA, vascular calcification and fracture risk in dialysis patients. PLoS ONE. 2016;11(7). Doi: 10.1371/journal.pone.0158789.

9. Sun N., Guo Y., Liu W. FGF23 neutralization improves bone quality and osseointegration of titanium implants in chronic kidney disease mice. Sci Rep. 2015;5:8304. Doi: 10.1038/srep08304.

10. Fusaro M., Gallieni M., Aghi A., Rizzo M. A., Iervasi G., Nickolas T. L., Plebani M. Osteocalcin (bone GLA protein) levels, vascular calcifications, vertebral fractures and mortality in hemodialysis patients with diabetes mellitus. J Nephrol. 2019. Doi: 10.1007/s40620-019-00595-1.

11. Misch C. E. Density of bone: effect of treatment plans, surgical approach, healing and progressive bone loading. Int. J. Oral Implantol. 1990;6(2):23–30.

12. Dulaev A. K., Tsed A. N., Filchenko I. A., Mushtin N. E. Features of the effect of various forms of vitamin d on the bone and joint system. The Scientific Notes of the Pavlov university. 2018;25(2):19–31. (In Russ.). Doi: https://doi.org;/10.24884/1607-4181-2018-25-2-19-31.

13. Christodoulou S., Goula T., Ververidis A., Drosos G. Vitamin D and Bone Disease. Biomed Res Int. 2013;(2013):1– 6. Doi: 10.1155/2013/396541.

14. Dulaev A. K., Tsed A. N., Mushtin N. E. The use of transexamic acid for total hip arthroplasty in chronic hemodialysis patients. Grekov’s Bulletin of Surgery. 2018; 177(4):47–51. (In Russ.). Doi: https://doi.org/10.24884/ 0042-4625-2018-177-4-47-51.