The Effect of Renal Transplantation in End-Stage Renal Failure Patients Undergoing Total Hip Replacement

Patients with end-stage renal failure (ESRF) undergoing elective orthopedic surgery generally have higher postoperative morbidity and mortality compared to the general population. Studies on the outcome of ESRF patients undergoing total hip replacement (THR), especially those with a functioning renal transplant, are conflicting. We aim to evaluate the impact of renal transplantation on functional outcome and postoperative complications in patients with ESRF undergoing THR.

A total of 29 primary THRs were performed in 25 patients with ESRF between 1999 and 2013. There were 12 patients with 14 THRs who had a functioning renal transplant at the time of surgery (transplant group), and 13 patients with 15 THRs who were dialysis dependent with either no or failed prior transplant (nontransplant group). Functional outcome was evaluated with the Oxford Hip Score (OHS) and Western Ontario and McMaster Universities Osteoarthritis Index. Clinical records and followup radiographs were used to evaluate postoperative complications.

There is lower mortality rate (P = 0.02) and lower overall complication rate in the transplant group compared to the nontransplant group (relative risk 0.60, 95% confidence interval 0.40-0.91, P = 0.008). The mean increase in OHS postoperatively was greater in the nontransplant group (nontransplant-24.7; transplant-18.7) and trended toward statistical significance (P = 0.06).

ESRF patients who undergo THR experience improvements in functional outcome regardless of transplant status. There was no significant difference in postoperative functional outcomes between the two groups of patients, but patients with renal transplants are less likely to experience postoperative complications and have better survival.