title: Is total hip arthroplasty safely performed in lung transplant patients? Current experience from a retrospective study of the Zurich lung transplant cohort.
abstract: BACKGROUND
  In recent years, the number of lung transplants has increased rapidly, with higher quality of life and improved survival rates in transplant recipients, including patients with advanced age. This, in turn, means that more transplant recipients will seek musculoskeletal care to treat degenerative joint disease and also trauma incidents. Safety concerns regarding elective and posttraumatic hip arthroplasty in transplant patients include an increased risk of infection, wound healing problems, periprosthetic fractures and loosening of the implants.
  
  
  METHODS
  Clinical outcomes and safety aspects were retrospectively reviewed for five primary total hip arthroplasties (THA) in lung transplant recipients with minimal follow-up of two years at average of 2.6 (2-11) years. Patients were recruited from the Zurich Lung Transplant Center comprising of a cohort of 253 patients between January 1st, 2004 and December 31st, 2013.
  
  
  RESULTS
  All five patients subjectively reported excellent outcomes after THA with a final average Harris Hip Score of 97 (86-100). One 71-year-old patient died 26 months after THA unrelated to arthroplasty. One superficial wound healing disturbance was documented. No periprosthetic fractures, no dislocations, no periprosthetic infections, no further revision surgery, no implant loosening was observed.
  
  
  CONCLUSIONS
  In conclusion, THA can be safely and successfully performed even in lung transplant patients under long-term immunosuppressive therapy and polymedication, provided a multidisciplinary approach can be granted.
authors.affiliation: Department of Trauma Surgery, University Hospital Zurich, CH-8091 Zurich, Switzerland ; Department of Pulmonology, University Hospital Zurich, CH-8091 Zurich, Switzerland.
authors.forename: Jürgen W
authors.initials: JW
authors.lastname: Schmitt
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, CH-8091 Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.affiliation: Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Dora
authors.affiliation: Department of Trauma Surgery, University Hospital Zurich, CH-8091 Zurich, Switzerland.
authors.forename: Clément M L
authors.initials: CM
authors.lastname: Werner
keywords: Antibiotic treatment; Complications; Hip arthroplasty; Immunosuppression; Lung transplantation; Osteonecrosis; Safety