Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review

Abstract

Objectives End-stage renal disease (ESRD) patients are at an increased risk of needing total joint arthroplasty (TJA); however, both dialysis and renal transplantation might be potential predictors of adverse TJA outcomes. For dialysis patients, the high risk of blood-borne infection and impaired muscular skeletal function are threats to implants’ survival, while for renal transplant patients, immunosuppression therapy is also a concern. There is still no high-level evidence in the published literature that has determined the best timing of TJA for ESRD patients. Methods A literature search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to November 2019) was performed to collect studies comparing TJA outcomes between renal transplant and dialysis patients. Two reviewers independently conducted literature screening and quality assessments with the Newcastle-Ottawa Scale (NOS). After the data were extracted, statistical analyses were performed. Results Compared with the dialysis group, a lower risk of mortality (RR = 0.56, Cl = [0.42, 0.73], P < 0.01, I2 = 49%) and revision (RR = 0.42, CI = [0.30, 0.59], P < 0.01, I2 = 43%) was detected in the renal transplant group. Different results of periprosthetic joint infection were shown in subgroups with different sample sizes. There was no significant difference in periprosthetic joint infection in the small-sample-size subgroup, while in the large-sample-size subgroup, renal transplant patients had significantly less risk (RR = 0.19, CI = [0.13, 0.23], P < 0.01, I2 = 0%). For dislocation, venous thromboembolic disease, and overall complications, there was no significant difference between the two groups. Conclusion Total joint arthroplasty has better safety and outcomes in renal transplant patients than in dialysis patients. Therefore, delaying total joint arthroplasty in dialysis patients until renal transplantation has been performed would be a desirable option. The controversy among different studies might be partially accounted for that quite a few studies have a relatively small sample size to detect the difference between renal transplant patients and dialysis patients.

Kidney transplant outcomes among recipients with post‐transplant hip or knee joint replacement surgery

“…Patients with end‐stage renal disease (ESRD) are at a higher risk of needing joint arthroplasty or replacement surgery due to this population's high prevalence of osteonecrosis, osteoarthritis, renal osteodystrophy, and steroid and/or other immunosuppressive drug use with accompanying amyloid deposition 1 . An estimated 80% of ESRD patients on hemodialysis have chronic musculoskeletal pain, particularly joint pain, with hip pain being the most common 2 .…”

“…8 Patients with ESRD who undergo kidney transplantation may need to have joint replacement surgery even before undergoing transplant, and in these cases, joint pain may even be exacerbated post-transplant due to the requirement of life-long immunosuppression, including steroids. 1,9,10 Most studies have assessed the surgical risks of joint replacement viability in patients with ESRD who have either had a kidney transplant or are on dialysis. [10][11][12][13] The increased revision rates and decreased survival of the joint replacement in patients on dialysis make performing joint replacements in pre-transplant patients challenging.…”

Greek gods and the double-edged sword of liver regeneration

“…As a consequence of renal osteodystrophy, steroid use, amyloid deposition and immunosuppressive therapy after renal transplant, patients with end-stage renal disease (ESRD) have an increased risk of osteonecrosis and osteoarthritis [ 36 ]. Accordingly full hip replacement and full knee replacement are more often required in this patient group than in the general population [ 37 ].…”

“…Accordingly full hip replacement and full knee replacement are more often required in this patient group than in the general population [ 37 ]. It has been shown that total knee arthroplasty (TKA) leads to high patient satisfaction regarding quality of life and pain relief [ 38 ], although ESRD on its own is a risk factor for perioperative complications [ 36 , 37 , 39 , 40 ].…”

Comparison of Total Knee Arthroplasty Outcomes Between Renal Transplant and End Stage Renal Disease Patients

“…This is particularly problematic because both treatments have been associated with amyloid deposition, osteonecrosis, renal osteodystrophy, and osteoarthritis, all of which increase the need for TJA. 6,[12][13][14][15] Thus, a deeper understanding of the interplay between ESRD, RT, and TJA outcomes is necessary to better care for patients who simultaneously have a greater need for TJA and a greater risk for adverse complications after TJA.…”