title: Hip arthroplasty in chronic dialysis patients.
abstract: We retrospectively reviewed 15 patients (24 hips) on chronic renal dialysis who underwent hip arthroplasty between 1970 and 1990. The average age at surgery was 39 years; the average follow-up was 8 years (range, 1-19 years). All follow-up of less than 5 years relates to those patients who died. Of these 24 hips, 14 (58%) failed or were failing due to loosening; the average time to revision was 7 years (range, 1.5-14 years). A complicated course was experienced in 16 hips (66%), primarily related to medical difficulties. There was one perioperative death. The following orthopedic complications afflicted 5 hips (21%): one femur fracture during revision; one femur fracture at 2 months after revision; one dislocation during seizure; one displacement of acetabular cup requiring recementing; and late generalized septic death of one patient (with both hips involved). Within an average of 3 years (range, 15 months to 7 years) after their index surgery, 6 of the 15 patients (40%) died. The patients who lived were chronically ill, and all but three remained on long-term dialysis. The functional level of all those remaining on dialysis steadily declined, and none reached a quality of life comparable to an osteoarthritic patient. This study confirms a previously reported high mortality and morbidity rate in this population. Despite their difficulties, 22/24 primary hips were relieved of pain and increased in function; six patients returned to work. We see no better alternative for pain relief in total hip arthroplasty, particularly in view of contemporary surgical techniques and improved medical management.
authors.affiliation: Orthopedic Physician Associates, Seattle, Washington 98104, USA.
authors.forename: H E
authors.initials: HE
authors.lastname: Toomey
authors.forename: S D
authors.initials: SD
authors.lastname: Toomey
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005271:Femur Head Necrosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D006435:Renal Dialysis; D012086:Reoperation; D015996:Survival Rate