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Open Access
CC BY 4.0 · J Knee Surg
DOI: 10.1055/a-2756-0149
Original Article

Renal Osteodystrophy as a Risk Factor for Postoperative Complications after Knee Arthroplasty: A National In-Patient Sample Study

Autor*innen

  • WeiLong Zhong   ‡

    1   Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

  • Binbin Zhu   ‡

    2   Comprehensive Intensive Care Unit of The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

  • Ying Xu    ‡

    3   Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

  • Hao Xie

    3   Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

  • ZhiGang Ai   ‡‡

    1   Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

  • Jian Wang   ‡‡

    3   Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

Funding Information None.
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Abstract

Renal osteodystrophy (ROD), a skeletal complication of chronic kidney disease (CKD)–mineral and bone disorder, may influence perioperative outcomes after total knee arthroplasty (TKA), but its impact remains unclear. This study examined patient characteristics, hospital resource utilization, and postoperative complications in ROD patients undergoing primary TKA. We performed a retrospective cohort analysis of the National Inpatient Sample (2010–2019). Adults undergoing primary TKA were identified and stratified by ROD status. Propensity score matching (PSM; 1:20) was used to balance age, sex, race, comorbidities, and CKD stage. Outcomes included length of stay (LOS), hospital charges, and medical and surgical complications. Among 1,196,522 TKA patients, 283 (0.02%) had ROD. After matching (n = 5,337 controls), ROD patients had a longer median LOS (3 vs. 3 days; p < 0.001) and markedly higher median hospital charges ($58,550 vs. $18,004; p < 0.001). ROD was associated with increased odds of medical complications, including thrombocytopenia (OR: 3.2; 95% CI: 1.9–5.2), convulsion (OR: 6.9; 2.5–19.6), heart failure (OR: 2.3; 1.5–3.4), chest pain (OR: 3.4; 1.2–10.0), acute cerebrovascular disease (OR: 3.0; 1.4–6.4), stroke (OR: 3.3; 1.6–6.8), pneumonia (OR: 3.9; 1.7–9.0), and acute renal failure (OR: 2.3; 1.6–3.5). Surgical risks were also elevated, notably periprosthetic fracture (OR: 7.1; 2.2–22.9), joint dislocation (OR: 4.6; 1.7–12.3), and lower limb peripheral nerve injury (OR: 2.5; 1.4–4.7). ROD patients undergoing primary TKA incur greater hospital resource use and substantially higher rates of diverse medical and surgical complications. These findings highlight ROD as an independent risk factor warranting targeted preoperative risk stratification, multidisciplinary perioperative planning, and bone health optimization to improve outcomes and resource efficiency in this high-risk population.

The level of evidence is 3.

Trial registration is not applicable.

Keywords

knee arthroplasty - renal osteodystrophy - complication - National Inpatient Sample

Data Availability Statement

The datasets used and analyzed during the current study are available from the corresponding authors on reasonable request.


Contributors' Statement

Y.X. created the figures, tables, and wrote the first draft. H.X. was the primary investigator of the study and operated on patients. Y.X., H.X., W.Z., B.Z., Z.A., and J.W.—all aided in interpreting and analyzing data, drafted the article, and approved the current version of the paper.


Ethical Approval

Our IRB determined that this study was exempt from clearance because the data were de-identified and readily available to the public.


Informed Consent

Not applicable.


‡ These are the co-first authors and contributed equally to the article.


‡‡ These authors contributed equally to the article.


Supplementary Material



Publikationsverlauf

Eingereicht: 03. Dezember 2024

Angenommen: 25. November 2025

Accepted Manuscript online:
27. November 2025

Artikel online veröffentlicht:
30. Dezember 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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