Outcomes of total hip arthroplasty in haemodialysis and renal transplant patients: systematic review

Popat, Ravi; Ali, Adam M.; Holloway, Ian; Sarraf, Khaled M; Hanna, Sammy A.

doi:10.1177/1120700019877835

Cited by 22 publications

(23 citation statements)

References 31 publications

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“…This meta-analysis's main finding is that arthroplasties performed in renal transplant patients have a lower risk of mortality, periprosthetic joint infection, and revision than those performed in dialysis patients. To our knowledge, this is the first meta-analysis on this topic, even though Lieu et al's [27] and Popat et al's [28] systematic reviews have been published. Unlike previous systematic reviews, this review provides a higher level of evidence due to the meta-analysis performed.…”

Section: Discussionmentioning

confidence: 95%

“…This was also supported by the research of Malkani et al [9], who performed multivariate Cox regressions, including patient factors and hospital factors. Although a consensus on the infection rate has not yet been reached, most authors have supported that renal transplant patients' infection rate was acceptable and that TJA was a reasonable therapeutic option in those patients [12,28,30,36].…”

Section: Discussionmentioning

confidence: 99%

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

Peng

et al. 2020

J Orthop Surg Res

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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.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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

Peng

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…This was also supported by the research of Malkani et al (9), who performed multivariate Cox regressions, including patient factors and hospital factors. Although a consensus on the infection rate has not yet been reached, most authors have supported that the infection rate in renal transplant patients was acceptable and that TJA was a reasonable therapeutic option in those patients (12,28,30,36).…”

Section: Discussionmentioning

confidence: 99%

“…Due to inadequate bone stock, most studies have adopted cemented implants, and the results have been satisfactory. Some evidence suggests that cementless implants are also reliable in renal transplant patients (30,40), and Popat et al (28) concluded that cementless implants appeared to be associated with lower failure rates in both hemodialysis patients and renal transplant patients. However, long-term validation for cementless implants is still lacking and heterogeneity in Popat's research is a concern.…”

Section: Discussionmentioning

confidence: 99%

Total Joint Arthroplasty Has Better Safety and Outcomes in Renal Transplant Patients Than in Dialysis Patients—A Meta-Analysis and Systematic Review

Peng

et al. 2020

Preprint

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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 the survival of implants, 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 that compared TJA outcomes between renal transplant patients and dialysis patients. Literature screening and quality assessments with the Newcastle-Ottawa scale (NOS) were conducted by two reviewers. 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 qiute small sample size to detect the difference between renal transplant patients and dialysis patients.

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“…The most recent meta-analysis was performed by Popat et al, but this study only included patients who underwent THA. 6 In this study, we performed a comprehensive review assessing the outcome of total knee arthroplasty (TKA) and total hip arthroplasty (THA) in patients who are currently receiving dialysis or have had a KT. Specifically, we reviewed literature published after the year 2000 to answer the following questions: (1) What is the mortality rate after TJA?…”

Section: Introductionmentioning

confidence: 99%

Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis

et al. 2021

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Patients with end-stage renal disease (ESRD) have inferior outcomes after hip and knee total joint arthroplasty (TJA), with higher risk for surgical site complications (SSC) and periprosthetic joint infection (PJI). We conducted a systematic review and meta-analysis regarding outcomes after hip and knee TJA in ESRD patients who have received dialysis or a kidney transplant (KT) using PubMed, MEDLINE, Cochrane Reviews, and Embase in order to: (1) determine the mortality and infection rate of TJA in patients receiving dialysis or KT and (2) to identify risk factors associated with the outcome. We included 22 studies and 9384 patients (dialysis, n = 8921, KT, n = 463). The overall mortality rate was 14.9% and was slightly higher in KT patients (dialysis vs. KT, 13.8% vs. 15.8%). The overall SSC rate was 3.4%, while dialysis and KT patients each had an incidence of 3.3% and 3.6%, respectively. For PJI, the overall rate was 3.9%, while the incidence for dialysis patients was 4.0% and for KT patients was 3.7%. Using multi-regression analysis, age, sex, the type of arthroplasty (knee or hip) performed, and the form of renal replacement therapy (dialysis or KT) were not significant risk factors. In patients on dialysis or who had received a KT, TJA is associated with a slight increase in mortality, SSC and PJI rates. Cite this article: EFORT Open Rev 2021;6:618-628. DOI: 10.1302/2058-5241.6.200116

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Outcomes of total hip arthroplasty in haemodialysis and renal transplant patients: systematic review

Cited by 22 publications

References 31 publications

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

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

Total Joint Arthroplasty Has Better Safety and Outcomes in Renal Transplant Patients Than in Dialysis Patients—A Meta-Analysis and Systematic Review

Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis

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