Timing of Renal Transplant Before Total Hip Arthroplasty Impacts 2-Year Postoperative Outcomes

Renal transplant (RT) patients are at increased risk for complications after total hip arthroplasty (THA); however, it is unknown if the time from RT to THA influences such risks. This study evaluated RT patients undergoing primary THA at various time intervals after transplant. We hypothesized that increased time between RT and THA would decrease the risk of complications after THA.

A national database was used to review 737 RT patients who underwent subsequent primary THA for osteoarthritis and osteonecrosis from 2010 to 2020. Patients were stratified by intervals of < 1 year (n = 95), between 1 and 2 years (n = 142), and >2 years (n = 500) from RT to THA. Medical complications up to 90 days, readmissions, and 2-year revisions were compared.

There was a lower incidence of acute kidney injury (AKI; 36, 28, and 24%, respectively; P = 0.03), periprosthetic fracture (4, 0, and 0%, respectively; P < 0.01), and all-cause revision (13, 12, and 7%, respectively; P < 0.01) in the > 2-year cohort. There was a higher incidence of all-cause revision in the <1-year cohort (13, 12, and 7%, respectively; P < 0.01). A THA > 2 years after RT was associated with decreased 90-day medical complications, including AKI (odds ratio [OR] 0.55, confidence interval [CI] 0.35 to 0.88; P < 0.01) and wound dehiscence (OR 0.36, CI 0.15 to 0.88; P = 0.04), as well as decreased risk of periprosthetic fracture (OR 0.16, CI 0.02 to 0.98; P = 0.05) at 2 years.

Renal transplant patients undergoing THA 2 years from transplant have a decreased risk of postoperative AKI, wound dehiscence, and periprosthetic fracture. Although surgical timing is patient specific, waiting 2 years after RT before proceeding with THA may improve both medical and surgical outcomes.