Patients who have kidney failure are at higher risk of requiring total hip arthroplasty and are at higher risk of complications. This study compared the rate of revision surgery and mortality following total hip arthroplasty between patients who have kidney failure receiving long term dialysis or who had a kidney transplant and those who did not have kidney failure.
A data linkage study was performed using data from two national registries: a registry of dialysis and kidney transplant patients and a registry of total hip arthroplasty procedures. Both registries had coverage of almost all procedures or treatments in Australia. Data from September 1999 to December 2016 were used. Mortality and revision surgery were compared between patients receiving dialysis, those who had a functioning kidney transplant, and patients who did not have kidney failure using Cox and Fine-Gray (competing risk) regression models. A total of 383,478 primary total hip arthroplasty procedures were identified as people receiving dialysis (n=490), who had a functioning kidney transplant (n=459), or who did not have kidney failure (n=382,529).
There was no significant difference in the overall rate of revision surgery between the groups (dialysis vs no kidney failure HR = 1.20; 95% CI 0.76, 1.88, transplant vs no kidney failure HR = 1.01; 95%CI 0.66, 1.53). The risk for death post-surgery was significantly higher in the dialysis group compared to both the functioning transplant group (HR = 3.44; 95%CI 1.58, 7.5), and in those without kidney failure (HR = 4.13; 95%CI 3.25, 5.25).
The rate of mortality after total hip arthroplasty in patients on dialysis is higher than in patients who have a functioning transplant or those who do not have kidney failure, but there is no early excess mortality to suggest a difference in this metric due to the surgery.
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