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Reducing Risk in Total Joint Arthroplasty

Immunocompromised Patients

Mehrotra, Kapil MD; Mayman, David J. MD

doi: 10.1097/BTO.0000000000000390

Immunodeficiency limits the body’s natural ability to fight infection, thus increasing the patient’s risk of postoperative complications. Moreover, rates of immunosuppression in the United States are on a steady climb secondary to the duality of greater life expectancy of the immunosuppressed and expanding indications for immunosuppressant use. Taken together, these 2 factors foreshadow the growing challenge orthopedic surgeons will face, as higher rates of immunocompromised patients will inevitably present for procedures in the decade ahead. These patients present with the 3-fold effect of a weakened ability to heal, fight infections, and maintain homeostasis. In the surgeon’s armamentarium must be a thorough understanding of the mechanisms behind the immunocompromised state, the complications to remain vigilant of, and the consequences of failure. The surgeon should seek assistance from other specialists early and make sure the patient is informed of elevated risks before proceeding. Further research is needed to optimize the care of this patient population.

Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY

This project was supported by an unrestricted grant from KCI, an Acelity company. Project management support was provided by MedicusWorks.

The authors declare that they have nothing to disclose.

For reprint requests, or additional information and guidance on the techniques described in the article, please contact David J. Mayman, MD, at or by mail at Hospital for Special Surgery, 541 E 71st St, 6th floor, New York, NY 10021. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.

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