{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T23:11:34Z","timestamp":1778713894405,"version":"3.51.4"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Renal osteodystrophy (ROD), a skeletal complication of chronic kidney disease (CKD)\u2013mineral 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\u20132019). 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\u2009=\u20095,337 controls), ROD patients had a longer median LOS (3 vs. 3 days; p\u2009&lt;\u20090.001) and markedly higher median hospital charges ($58,550 vs. $18,004; p\u2009&lt;\u20090.001). ROD was associated with increased odds of medical complications, including thrombocytopenia (OR: 3.2; 95% CI: 1.9\u20135.2), convulsion (OR: 6.9; 2.5\u201319.6), heart failure (OR: 2.3; 1.5\u20133.4), chest pain (OR: 3.4; 1.2\u201310.0), acute cerebrovascular disease (OR: 3.0; 1.4\u20136.4), stroke (OR: 3.3; 1.6\u20136.8), pneumonia (OR: 3.9; 1.7\u20139.0), and acute renal failure (OR: 2.3; 1.6\u20133.5). Surgical risks were also elevated, notably periprosthetic fracture (OR: 7.1; 2.2\u201322.9), joint dislocation (OR: 4.6; 1.7\u201312.3), and lower limb peripheral nerve injury (OR: 2.5; 1.4\u20134.7). 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.<\/jats:p>\n                  <jats:p>The level of evidence is 3.<\/jats:p>\n                  <jats:p>Trial registration is not applicable.<\/jats:p>","DOI":"10.1055\/a-2756-0149","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:51:24Z","timestamp":1764291084000},"page":"355-363","source":"Crossref","is-referenced-by-count":0,"title":["Renal Osteodystrophy as a Risk Factor for Postoperative Complications after Knee Arthroplasty: A National In-Patient Sample Study"],"prefix":"10.1055","volume":"39","author":[{"given":"WeiLong","family":"Zhong","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Binbin","family":"Zhu","sequence":"first","affiliation":[{"name":"Comprehensive Intensive Care Unit of The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9505-9202","authenticated-orcid":false,"given":"Ying","family":"Xu","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ZhiGang","family":"Ai","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Xie","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1111\/os.13008","article-title":"Incidence and risk factors of in-hospital prosthesis-related complications following total knee arthroplasty: A retrospective Nationwide Inpatient Sample database study","volume":"13","author":"Q-F Yang","year":"2021","journal-title":"Orthop Surg"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s43019-023-00196-0","article-title":"Total knee arthroplasty in dialysis patients: A national in-patient sample-based study of perioperative complications","volume":"35","author":"N Venishetty","year":"2023","journal-title":"Knee Surg Relat Res"},{"issue":"17","key":"ref3","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"M Sloan","year":"2018","journal-title":"J Bone Joint Surg Am"},{"key":"ref4","volume-title":"Chronic Kidney Disease in the United States, 2023","year":"2023"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/MNH.0000000000000918","article-title":"Renal osteodystrophy: something old, something new, something needed","volume":"32","author":"V David","year":"2023","journal-title":"Curr Opin Nephrol Hypertens"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1016\/j.arth.2016.12.006","article-title":"Chronic kidney disease is an independent risk factor for transfusion, cardiovascular complication, and thirty-day readmission in minimally invasive total knee arthroplasty","volume":"32","author":"F-C Kuo","year":"2017","journal-title":"J Arthroplasty"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"3291","DOI":"10.1007\/s00402-022-04581-4","article-title":"Does systemic lupus erythematosus impact the peri-operative complication rates following primary total knee arthroplasty? 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