Assessing the impact of dialysis on short, intermediate, and long-term outcomes following total hip arthroplasty: a propensity-matched analysis.

INTRODUCTION: Patients requiring dialysis are historically associated with poor outcomes and increased rates of complications following total hip arthroplasty (THA). However, earlier studies have not analysed patients with end-stage renal disease (ESRD) under matched conditions with large cohorts. This study compares short-, mid-, and long-term postoperative outcomes of THA between matched cohorts of dialysis-dependent and non-dialysis patients. METHODS: We conducted a retrospective cohort study using the TriNetX global research network, identifying patients undergoing primary THA between 2005 and 2025. We formed 2 cohorts, with 1 comprised of renal disease patients requiring dialysis and the other including patients without any instance of dialysis before or after surgery. Propensity score matching was performed based on demographics and comorbidities, resulting in 707 matched patients per group. Outcomes were assessed at 90 days, 2 years, and 5 years. Primary outcomes included short-term rates of any adverse event (AAE) and surgical site infection and rates of infected hip prosthesis and revision THA at all time points. RESULTS: Dialysis-dependent patients experienced significantly worse outcomes across all time points. At 90 days, rates of AAE were nearly double in the dialysis group (24.5% vs. 13.6%, p < 0.001), with higher rates of infected hip prosthesis (4.4% vs. 1.4%, p = 0.001). SSI rates were higher but not significant (2.4% vs. 1.4%, p = 0.174), and revision THA trended towards significance (2.5% vs. 1.4%, p = 0.127). At 2 years, dialysis patients had higher rates of an infected hip prosthesis (6.1% vs. 2.3%, p < 0.001) and revision THA (5.0% vs. 2.4%, p = 0.011). These disparities persisted at 5 years, with dialysis patients exhibiting higher rates of an infected hip prosthesis (6.6% vs. 2.5%, p < 0.001) and revision THA (6.1% vs. 2.7%, p = 0.002). CONCLUSIONS: Dialysis-dependent patients undergoing THA face significantly higher rates of short-term and long-term orthopedic complications. Surgeons should discuss with patients the demonstrated elevated risk of complications with elective THA in patient's dependent on dialysis.