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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

Authors

  • WeiLong Zhong

    1   Department of anesthesiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (Ringgold ID: RIN144991)

  • BinBin Zhu

    2   Comprehensive intensive care unit, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (Ringgold ID: RIN144991)

  • Ying Xu 

    3   Department of Orthopaedics, Southern Medical University First Affiliated Hospital, Guangzhou, China (Ringgold ID: RIN198153)

  • Hao Xie

    3   Department of Orthopaedics, Southern Medical University First Affiliated Hospital, Guangzhou, China (Ringgold ID: RIN198153)

  • Jian Wang

    3   Department of Orthopaedics, Southern Medical University First Affiliated Hospital, Guangzhou, China (Ringgold ID: RIN198153)

  • ZhiGang Ai

    1   Department of anesthesiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (Ringgold ID: RIN144991)
Further Information
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Background: Renal osteodystrophy (ROD), a skeletal complication of chronic kidney disease–mineral and bone disorder (CKD-MBD), 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. Methods: 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 (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. Results: 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). Conclusion: 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.



Publication History

Received: 03 December 2024

Accepted after revision: 25 November 2025

Accepted Manuscript online:
27 November 2025

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