【Abstract】 Objective To explore the effect of total parathyroidectomy combined with autogenous forearm transplantation on secondary hyperparathyroidism of renal failure and the change of serum calcium and parathyroid hormone. Methods From May 2013 to may 2017, 100 patients with secondary hyperparathyroidism due to renal failure were randomly divided into the control group and the study group, with 50 cases in each group. The control group was treated with subtotal parathyroidectomy. The study group was treated with parathyroidectomy and forearm transplantation. The improvement of clinical symptoms was observed before and 6 months after operation. The levels of serum calcium, phosphorus, parathyroid hormone, alkaline phosphatase (ALP), hemoglobin (Hgb) and albumin (ALB) were measured. The quality of life of the two groups before and 6 months after operation was evaluated. Results After treatment, the incidence of skin pruritus, bone and joint pain, restless legs syndrome and ectopic calcification in the two groups were statistically significant (P＜005), but there was no significant difference between the observation group and the treatment group (P＞0.05). There was no significant difference in serum calcium, phosphorus, parathyroid hormone, ALP, HGB and ALB between the two groups before treatment (P＞0.05). After treatment, there was no significant difference in blood phosphorus level, ALP, HGB and ALB between the study group and the control group (P＞0.05), but the level of blood calcium and parathyroid hormone in the study group was significantly higher than that in the control group (P＜0.05). ALP in the study group was significantly lower than that in the control group (P＜0.05). Before treatment, there was no significant difference in the scores of role function, cognitive function, physical function and social function between the study group and the control group (P＞0.05). After treatment, the scores of role function, cognitive function, physical function and social function in the study group were higher than those in the control group (P＜0.05). Conclusion In the treatment of hyperparathyroidism secondary to renal failure, total parathyroidectomy combined with forearm transplantation has an ideal therapeutic effect, which can improve the level of blood calcium, parathyroid hormone, ALP, and the quality of life of patients, and it is worthy of reference for clinicians.