Joint Arthroplasty in Patients with Chronic Kidney Disease and Solid Organ Transplants

Joint arthroplasty, encompassing hip, knee and shoulder replacement, has transformed mobility in patients with degenerative joint disease. Those with chronic kidney disease (CKD) and solid organ transplants (SOT) represent expanding cohorts with complex needs. CKD associates with bone mineral density loss, anaemia and cardiovascular comorbidity, while dialysis dependence or immunosuppression after transplant elevates infection risk and impairs wound healing. Interdisciplinary approaches to perioperative management now emphasise preoperative optimisation of renal function, stringent infection prophylaxis and tailored rehabilitation. Advances in implant technology, including cementless and bioactive coatings, have demonstrated promising mid-term fixation in dialysis recipients. Similarly, refined immunosuppressive regimens and surgical protocols have reduced some complications in transplant recipients undergoing joint replacement. Nevertheless, these groups continue to show higher rates of transfusion, intensive care admission and prolonged hospital stay, underlining the need for vigilant monitoring and bespoke care pathways to optimise outcomes and quality of life on a global scale.

Research from Nature Portfolio

Recent analysis of hip arthroplasty in chronic renal failure patients on dialysis reported excellent radiological outcomes and substantial functional improvement with cementless implants over a mean follow-up of three years. Implant survival exceeded 90 per cent at 10–15 years, but perioperative complications, notably blood transfusion and shunt dysfunction, remained significant. This work underscores the viability of cementless strategies in dialysis patients while highlighting the critical role of comprehensive perioperative planning to mitigate morbidity.

Joint Arthroplasty in Patients with Chronic Kidney Disease and Solid Organ Transplants publication trend

The graph below shows the total number of articles in joint arthroplasty in patients with chronic kidney disease and solid organ transplants across all publications each year (not limited to Nature Index journals).

Technical terms

Joint arthroplasty: Surgical replacement of a diseased joint with a prosthetic implant.

Chronic kidney disease (CKD): Progressive decline in renal function often leading to end-stage renal disease.

Solid organ transplant (SOT): Transplantation of organs such as kidney, liver or heart, requiring lifelong immunosuppression.

Periprosthetic joint infection (PJI): Infection surrounding a joint implant, a serious complication often necessitating revision surgery.

End-stage renal disease (ESRD): Final stage of CKD characterised by dependence on dialysis or transplantation.

Revision arthroplasty: Repeat joint replacement performed to address implant failure or complications.

Aseptic loosening: Implant failure due to loss of fixation without evidence of infection.

References

1. Hip arthroplasty for patients with chronic renal failure on dialysis. Scientific Reports (2023).
2. Total knee arthroplasty in dialysis patients: a national in-patient sample-based study of perioperative complications. Knee Surgery & Related Research (2023).
3. Revision Total Hip Arthroplasty in Solid Organ Transplant Patients: A Propensity Score-Matched Cohort Study for Aseptic and Infected Revisions. Arthroplasty Today (2022).
4. The Influence of Solid Organ Transplant on Inpatient Complications, Length of Stay, and Hospital Costs in Reverse Shoulder Arthroplasty Patients. Cureus (2024).