Abstract
Severe comorbidities, like chronic kidney disease, strongly associated with higher risk of complications after total knee arthroplasty. Therefore hemodialysis patients need specific pre-operative as well as peri-operative management, including proper analgesic, antibacterial and thromboembolic pharmacological prophylaxis. Nevertheless the technical issues that surgeon has to solve in achieving proper leg alignment, knee stability and range of motion does not differ from other complex knee primary cases when revision implants and instruments are essential part of surgical requisite.