The current study retrospectively reviewed the
surgical outcomes following hip fractures in uremic patients undergoing
long-term hemodialysis and compared the results with those of geriatric
patients with osteoporotic hip fractures during 1-year period.Thirteen
complications occurred among the 21 uremic patients who underwent surgical
intervention for a hip fracture. Two complications were related to the failure
of osteosynthesis procedures after femoral neck fractures. While comparing
perioperative parameters between the 2 groups, patients in the uremic group had
younger age, more comorbidities, lower preoperative hemoglobin levels and
platelet counts, and an increased requirement of perioperative blood
transfusion. Statistical analysis revealed a significant increase in incidence
of postoperative complications in the uremic patients; however, the incidence of surgery-related complications was unchanged.
In conclusion, the present study shows that the incidence of perioperative
complications in hip fracture surgeries is higher in uremic patients than those
in geriatric hip fractures, mainly resulting from their comorbidities. In
addition, we recommend hip prosthesis replacement surgery for femoral neck
fractures in uremic patients due to the high rate of implant failure.
Cite this paper
Yu, Y. , Hsu, Y. , Chou, Y. , Tseng, I. , Yeh, W. and Wu, C. (2018). Higher Complication Rate Following Hip Fractures in Uremic Patients Undergoing Maintenance Hemodialysis: A Cohort Study. Open Access Library Journal, 5, e3986. doi: http://dx.doi.org/10.4236/oalib.1103986.
Coco, M. and Rush, H. (2000) Increased Incidence of Hip Fractures in Dialysis Patients with Low Serum Parathyroid Hormone. American Journal of Kidney Diseases, 36, 1115-1121. https://doi.org/10.1053/ajkd.2000.19812
Ball, A.M., Gillen, D.L., Sherrard, D., Weiss, N.S., Emerson, S.S., Seliger, S.L., Kestenbaum, B.R. and Stehman-Breen, C. (2002) Risk of Hip Fracture among Dialysis and Renal Transplant Recipients. JAMA, 288, 3014-3018. https://doi.org/10.1001/jama.288.23.3014
Picton, M.L., Moore, P.R., Mawer, E.B., Houghton, D., Freemont, A.J., Hutchison, A.J., Gokal, R. and Hoyland, J.A. (2000) Down-Regulation of Human Osteoblast PTH/PTHrP Receptor mRNA in End-Stage Renal Failure. Kidney International, 58, 1440-1449. https://doi.org/10.1046/j.1523-1755.2000.00306.x
Alem, A.M., Sherrard, D.J., Gillen, D.L., Weiss, N.S., Beresford, S.A., Heckbert, S.R., Wong, C. and Stehman-Breen, C. (2000) Increased Risk of Hip Fracture among Patients with End-Stage Renal Disease. Kidney International, 58, 396-399. https://doi.org/10.1046/j.1523-1755.2000.00178.x
Arneson, T.J., Li, S., Liu, J., Kilpatrick, R.D., Newsome, B.B. and St Peter, W.L. (2013) Trends in Hip Fracture Rates in US Hemodialysis Patients, 1993-2010. American Journal of Kidney Diseases, 62, 747-754. https://doi.org/10.1053/j.ajkd.2013.02.368
Nickolas, T.L., McMahon, D.J. and Shane, E. (2006) Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States. Journal of the American Society of Nephrology, 17, 3223-3232. https://doi.org/10.1681/ASN.2005111194
Tentori, F., McCullough, K., Kilpatrick, R.D., Bradbury, B.D., Robinson, B.M., Kerr, P.G. and Pisoni, R.L. (2014) High Rates of Death and Hospitalization Follow Bone Fracture among Hemodialysis Patients. Kidney International, 85, 166-173. https://doi.org/10.1038/ki.2013.279
Karaeminogullari, O., Demirors, H., Sahin, O., Ozalay, M., Ozdemir, N. and Tandogan, R.N. (2007) Analysis of Outcomes for Surgically Treated Hip Fractures in Patients Undergoing Chronic Hemodialysis. Journal of Bone and Joint Surgery, 89, 324-331.
Tosun, B., Atmaca, H. and Gok, U. (2010) Operative Treatment of Hip Fractures in Patients Receiving Hemodialysis. Musculoskeletal Surgery, 94, 71-75. https://doi.org/10.1007/s12306-010-0080-9
Vaughn, J., Cohen, E., Vopat, B.G., Kane, P., Abbood, E. and Born, C. (2015) Complications of Short versus Long Cephalomedullary Nail for Intertrochanteric Femur Fractures, Minimum 1-Year Follow-Up. European Journal of Orthopaedic Surgery & Traumatology, 25, 665-670. https://doi.org/10.1007/s00590-014-1557-2
Ha, Y.C., Baek, J.H., Ko, Y.B., Park, S.M. and Song, S.H. (2015) High Mortality and Poor Morbidity after Hip Fractures in Patients with Previous Vertebral Fractures. Journal of Bone and Mineral Metabolism, 33, 547-552. https://doi.org/10.1007/s00774-014-0616-4
Carpintero, P., Caeiro, J.R., Carpintero, R., Morales, A., Silva, S. and Mesa, M. (2014) Complications of Hip Fractures: A Review. World Journal of Orthopedics, 5, 402-411. https://doi.org/10.5312/wjo.v5.i4.402
Liu, Y., Peng, M., Lin, L., Liu, X., Qin, Y. and Hou, X. (2015) Relationship between American Society of Anesthesiologists (ASA) Grade and 1-Year Mortality in Nonagenarians under Hip Fracture Surgery. Osteoporosis International, 26, 1029-1033. https://doi.org/10.1007/s00198-014-2931-y
Lin, Z.Z., Wan, J.J., Chung, C.R., Huang, P.C., Su, B.A., Cheng, K.C., Chio, C.C. and Chien, C.C. (2014) Epidemiology and Mortality of Hip Fracture among Patients on Hemodialysis: Taiwan National Cohort Study. Bone, 64, 235-239. https://doi.org/10.1016/j.bone.2014.04.017
US Renal Data System (2005) USRDS 2005 Annual Data Report. The National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda.
Yang, W.C. and Hwang, S.J. (2008) Taiwan Society of Nephrology. Incidence, Prevalence and Mortality Trends of Dialysis End-Stage Renal Disease in Taiwan from 1990 to 2001: The Impact of National Health Insurance. Nephrology Dialysis Transplantation, 23, 3977-3982. https://doi.org/10.1093/ndt/gfn406
Konstantinidis, L., Papaioannou, C., Blanke, P., Hirschmüller, A., Südkamp, N.P. and Helwig, P. (2013) Failure after Osteosynthesis of Trochanteric Fractures. Where Is the Limit of Osteoporosis? Osteoporosis International, 24, 2701-2706. https://doi.org/10.1007/s00198-013-2392-8
Roden, M., Schon, M. and Fredin, H. (2003) Treatment of Displaced Femoral Neck Fractures: A Randomized Minimum 5-Year Follow Up Study of Screws and Bipolar Hemiprostheses in 100 Patients. Acta Orthopaedica Scandinavica, 74, 42-44.
https://doi.org/10.1080/00016470310013635
Haidukewych, G.J., Rothwell, W.S., Jacofsky, D.J., Torchia, M.E. and Berry, D.J. (2004) Operative Treatment of Femoral Neck Fractures in Patients between the Ages of Fifteen and Fifty Years. The Journal of Bone and Joint Surgery. American Volume, 86, 1711-1716. https://doi.org/10.2106/00004623-200408000-00015