Therapy of bone and joint changes in renal osteodystrophy in adulthood

The renal osteoarthropathy in patients with chronic renal disease undergoing hemodialysis is characterized by increased bone turnover. This is the consequence of secondary hyperparathyroidism and leads to fibro-osteoclasia and osteomalacia. Mineralization of the atypical bone fibers is diminished and the collagen texture is altered. The biomechanical properties of such bone are reduced, which means that the incidence of fractures is increased and fracture healing seems to be disturbed. Therapy given for renal failure leads to segmental necrosis of the epiphyses. In the growing skeleton longitudinal growth is diminished and deviations in the axes of long bones are often observed. Corrective osteotomies, treatment of fractures and artificial joint replacements are therefore necessary in patients with renal failure. Observations recorded in 13 patients (aged 16-67 years) with chronic renal insufficiency who underwent 21 surgical interventions and were followed up for 6 years have led to formulation of the following general recommendations. Corrective osteotomies should only be performed when they are absolutely essential; the rate of nonunions is very high. The same is true for fixation of fractures with plates and nails. When joint replacements are inserted because of segmental necrosis and fractures the course is almost the same as in patients without renal osteoarthropathy when bone cement is used for fixation.