| Theme |
Orthopedic Diseases Seen in Maintenance Dialysis Patients -- Surgical Indication and Non-indication |
| Title |
Surgical indications for and perioperative management of orthopaedic patients with dialysis-associated spondyloarthropathy |
| Author |
Yoshiharu Kato |
The Orthopedic Department, Tokyo Women's Medical University |
| [ Summary ] |
In dialysis patients β2-microglobulin (β2-MG) induce joint enthesopathy, initially resulting in the spondyloarthropathy and destruction of bone and cartilage. The pathogenesis of these lesions depends on the degree of bone turnover ranging from osteitis fibrosa (high) to aplastic bone conditions (low). Many cases of pseudoarthrosis arise in aplastic bone. Aabsolute indications for surgery are fractures refractory to conservative management, serious paralysis and severe arthropathy with serious pain as well as limited ROM. Care givers must decide whether surgical management is indicated or not by evaluating cardiac and pulmonary functions preoperatively. For orthopaedic surgery we must treat cardiac complications and intestinal bleeding as well as control mineral balance, perform transfusions and administer many medications. We must prepare adequate quantities of blood and platelets for transfusions as well as control blood pressure during surgery. |