Comparison of Postoperative Complications and Survivorship of Total Hip and Knee Arthroplasty in Dialysis and Renal Transplantation Patients

Chronic renal failure (CRF) is an established risk factor for surgical site infection (SSI) and periprosthetic joint infection (PJI) after primary total joint arthroplasty. However, there is limited literature comparing outcomes between patients who receive dialysis vs renal transplantation. We examined and compared clinical outcomes of patients receiving dialysis vs those who had a prior renal transplantation.

We retrospectively identified 107 patients undergoing primary total joint arthroplasty between 2000 and 2017, who were receiving dialysis ( n = 50), or had a prior renal transplantation ( n = 57). The cohorts were compared with respect to postoperative complications, including 90-day SSI, PJI, and failure resulting in revision procedure. Multivariate analysis was performed to determine independent risk factors for complications and revision.

A significantly higher rate of postoperative complications was seen in dialysis patients (28.0%) compared with renal transplant (7.1%). In particular, increased SSI and PJI rates were observed in dialysis group compared with the transplant cohort (18.0% vs 3.5%). In addition, increased revision rates (24.0% vs 3.5%) and decreased survivorship for the implant were observed in dialysis patients. Multivariate analysis revealed that patients with renal transplant were less likely to require revision arthroplasty and that total knee arthroplasty (vs total hip arthroplasty) was an independent risk factor for failure in dialysis patients.

This study provides further evidence that patients on dialysis who are on transplant list should await arthroplasty until transplant has taken place. In dialysis patients who are not transplant candidates, extreme care should be exercised, and additional strategies used to minimize the high complication rate that may be encountered.