Renal transplants are the most commonly performed solid-organ transplants worldwide. It is unclear whether a kidney transplant is associated with reduced postoperative complications in comparison with patients on dialysis for end-stage renal disease (ESRD). The purpose of this study was to utilize a national database to compare readmissions, complications, and costs associated with primary total hip arthroplasty (THA) between matched renal transplant recipients (RTRs) and patients on dialysis for ESRD.
Patients with a renal transplant (N = 1,401) and those on dialysis for ESRD (without a transplant) (N = 1,463) prior to being treated with a THA from 2010 to 2019 were identified within the PearlDiver database. RTRs and patients on renal dialysis were frequency-matched 1:1 on the basis of 9 patient characteristics, resulting in 582 patients in each group. Length of hospital stay, readmissions, complication rates up to 2 years, and total costs up to 1 year were compared between the groups using chi-square and multivariable logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Patients on renal dialysis had an increased mean length of stay (6.3 days) compared with RTRs (4.6 days, p < 0.01). After adjusting for age, tobacco use, and diabetes, patients on renal dialysis were more likely to be readmitted by 90 days (OR = 1.59; CI = 1.11 to 2.29, p < 0.01) and have mechanical complications (OR = 2.13; CI = 1.08 to 4.45, p = 0.03) and revisions (OR = 2.14; CI = 1.14 to 4.01, p = 0.01) by 2 years. Patients on renal dialysis were also more likely to have periprosthetic joint infections at 1 year (OR = 1.91; CI = 1.02 to 3.71, p = 0.04). Patients on dialysis incurred 14% higher costs at 1 year (p = 0.11).
Patients on renal dialysis had more readmissions, complications, and costs after THA when compared with RTRs. Specifically, patients on renal dialysis were more likely to have longer index lengths of stay, more readmissions by 90 days, and more mechanical complications and revision surgery by 2 years. Patients on dialysis also incurred higher costs and had greater odds of PJI. These results suggest that joint surgeons may consider delaying THA in suitable patients until after renal transplantation to reduce postoperative complications and costs.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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