Speakers - 2026

Title: Risk and Reward: Total Joint Arthroplasty After Heart Transplantation, Complication Rates and Functional Results

Abstract

Introduction:

As heart transplant survival rates have increased, more patients are experiencing serious joint issues that require THA/TKA. Concerns remain about complications and implant longevity in patients taking immunosuppression

Method:

We conducted a systematic review following PRISMA guidelines. Included were studies reporting outcomes of THA/TKA in heart transplant recipients. We evaluated patient-reported outcome measures, mortality, revision rates, and complications

Results:

18 studies included. Early medical complications were more common in cardiac transplant recipients (32% vs. 22%)

At 1 and 4 years, implant survivorship rates were 95.6% and 92.1%, respectively. Deep periprosthetic infection occurred in 3-4% of cases. Patient mortality was 2.9% at one year and 23.2% at four years, though heart recipients had lower mortality than lung recipients (RR 4.39).

Despite a higher perioperative risk, functional outcomes were favourable. Harris Hip Scores ranged from 71.8 to 88.6, and Knee Society Scores ranged from 79 to 88, with 82-100% of patients reporting good or excellent outcomes.

Conclusion:

Cardiac transplant recipients who undergo THA or TKA face higher complication rates around the time of surgery. However, they do see significant functional improvements after the procedure. Transplant specialists should be involved in multidisciplinary perioperative care. Patients should receive counselling regarding increased risks of bleeding, infection, death, and medical complications. To improve outcomes in this complex population, careful patient selection, preoperative optimisation, and rigorous postoperative monitoring are essential.