Outcomes of Primary Total Joint Arthroplasty After Lung Transplantation Cameron K. Ledford, MD , Tyler Steven Watters, MD, Samuel S. Wellman, MD, David E. Attarian, MD, Michael P. Bolognesi, MD Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina abstract article info Article history: Received 12 March 2013 Accepted 26 March 2013 Keywords: lung transplantation hip arthroplasty knee arthroplasty immunosuppression Lung transplantation is increasingly common with improving survival rates. Post-transplant patients can be expected to seek total hip (THA) and knee arthroplasty (TKA) to improve their quality of life. Outcomes of 20 primary total joint arthroplasties (15 THA, 5 TKA) in 14 patients with lung transplantation were reviewed. Clinical follow-up time averaged 27.5 and 42.8 months for THA and TKA respectively. Arthroplasty indications included osteonecrosis, osteoarthritis, and fracture. All patients subjectively reported good or excellent outcomes with a final average Harris Hip Score of 88.7, Knee Society objective and functional score of 92.0. There were 4 minor and 1 major acute perioperative complications. 1 late TKA infection was successfully treated with two-stage revision. The mortality rate was 28.5% (4/14 patients) at an average 20.6 months following but unrelated to arthroplasty. Overall, total joint arthroplasty can be safely performed and provide good functional outcomes in lung transplant recipients. © 2014 Elsevier Inc. All rights reserved. Lung transplantation is increasingly common worldwide. The International Society for Heart and Lung Transplantation recently reported that a total of 3519 lung transplantation procedures were performed in 2010, the highest registry reported number to date [1]. Like recipients of other solid organ transplants, these patients require lifelong treatment with corticosteroids and immunosuppressive agents to prevent and/or treat graft rejection. While necessary and responsible for improved survival, these therapies have distinct side effects that affect the musculoskeletal system. Chronic and high-dose steroid use can lead to osteonecrosis of joints, particularly the femoral head [2], which can lead to debilitating degenerative joint disease. In lung transplant recipients, the incidence of symptomatic osteonecrosis has been reported as 10% [3]. Moreover, pre-existing bone disease and post-transplant hormone-related bone loss in solid organ transplant recipients result in osteoporosis and fractures in up to 20%–40% of patients [4]. As the incidence of lung transplantation increases and survival continues to improve, more of these patients will seek orthopaedic surgeons for musculoskeletal care to address conditions such as degenerative joint disease, which can have a profound effect on their post-transplant quality of life. Concerns regarding the relative safety of elective arthroplasty in the post-transplant population include the potential increased risk of perioperative medical complications, increased risk of infection in the setting of chronic immunosuppres- sion, and increased risk of fracture or loosening in the setting of osteoporosis and bone loss. Outcomes of total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been reported previously in renal [5–8], cardiac [9–11], and liver transplant cohorts [12,13]. Interestingly, many of these studies have not identified an increased risk of periprosthetic infection, but do acknowledge an increased risk of overall complications in these populations. To the authors’ knowledge, however, no reports have been published on the outcomes of elective total joint arthroplasty in lung transplant recipients. The purpose of this study was to examine the outcome of total hip and knee arthroplasty following lung transplant with specific focus on perioperative complications and infection risk, in addition to functional outcomes. Materials and Methods This study retrospectively reviewed all patients who underwent primary total joint arthroplasty (TJA) following bilateral orthotopic lung transplantation at Duke University Medical Center between 2006 and 2012. 20 total joint arthroplasties in 14 pulmonary transplant recipients were identified through an internal surgical database search for both the ICD-9 code V42.6 (Lung replaced by transplant) and the Current Procedural Terminology code 27130 (THA) or 27447 (TKA). Patients were excluded if b 18 years old, did not have lung transplant prior to arthroplasty, failed or received N 1 lung transplant, or received additional or separate solid organ transplant. The Institutional Review Board approved the study prior to investigation. Lung transplantation was performed in patients with respiratory failure for pulmonary fibrosis, chronic obstructive pulmonary disease The Journal of Arthroplasty 29 (2014) 11–15 The Conflict of Interest statement associated with this article can be found at http:// dx.doi.org/10.1016/j.arth.2013.03.029. Reprint requests: Cameron Ledford, MD, Department of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Drive, Box 3000, Durham, NC 27710. 0883-5403/2901-0003$36.00/0 – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.arth.2013.03.029 Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org