Total Joint Arthroplasty Has Better Safety and Outcomes in Renal Transplant Patients Than in 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 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.