{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:17:12Z","timestamp":1788585432500,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Heart transplantation has evolved into a life-saving intervention for thousands of patients with end-stage disease worldwide. Advances in surgical techniques and immunotherapy have increased life expectancy in this specific patient group, resulting in the emergence of degenerative diseases such as osteoarthritis. Concurrently, due to the frequent administration of corticosteroids to transplant recipients, the rates of joint osteonecrosis remain high. This review aims to evaluate the final functional outcomes as well as the complications of patients with a history of heart transplantation who underwent total hip, knee, or shoulder arthroplasty. Methods: A systematic review of the literature was conducted according to PRISMA guidelines. The primary objective of the study was the improvement of various functional scores at the final clinical follow-up, as well as the recording of postoperative complication rates. Results: A total of 19 retrospective studies were included in the review, including small case series. Among the studies specifically evaluating functional outcomes, patients demonstrated statistically significant improvement in final clinical scores and quality of life. However, regarding complication rates, 12 out of the 19 articles identified a higher ratio compared to the general population, involving either systemic (e.g., renal failure), musculoskeletal (periprosthetic fracture, infection), or cardiac-related adverse events concerning the graft. Conclusions: According to the data analyzed in this systematic analysis, total arthroplasty of major joints demonstrates consistent potential to significantly improve the daily life and functional status of transplant patients. However, evidence regarding overall safety remains heterogeneous.<\/jats:p>","DOI":"10.3390\/jcm15176794","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:28:22Z","timestamp":1788280102000},"page":"6794","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes and Complications of Total Joint Arthroplasty in Heart Transplant Recipients: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2833-1655","authenticated-orcid":false,"given":"Alexandros","family":"Koskiniotis","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6832-0014","authenticated-orcid":false,"given":"George A.","family":"Komnos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1811-6290","authenticated-orcid":false,"given":"Antonios","family":"Koutalos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9494-6048","authenticated-orcid":false,"given":"Michael","family":"Hantes","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9043-0535","authenticated-orcid":false,"given":"Theofilos","family":"Karachalios","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3193-9566","authenticated-orcid":false,"given":"Sokratis","family":"Varitimidis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6784-6022","authenticated-orcid":false,"given":"Nikolaos","family":"Stefanou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20.00260","DOI":"10.5435\/JAAOSGlobal-D-20-00260","article-title":"The Influence of Geographic Region on Hip and Knee Arthroplasty Literature From 1988 to 2018","volume":"5","author":"Sinclair","year":"2021","journal-title":"JAAOS Glob. Res. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Stubnya, B.G., Schulz, M., V\u00e1ncsa, S., Szil\u00e1gyi, G.S., Szatm\u00e1ri, A., and Bejek, Z. (2025). Global Trends in Joint Arthroplasty: A Systematic Review and Future Projections. J. Clin. Med., 14.","DOI":"10.3390\/jcm14228214"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3810","DOI":"10.1007\/s10620-023-08012-1","article-title":"Survival Benefit of Solid-Organ Transplantation: 10-Year Update","volume":"68","author":"Ferreira","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.athoracsur.2013.08.040","article-title":"Surviving 20 years after heart transplantation: A success story","volume":"97","author":"Emmert","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jor.2024.02.003","article-title":"Hip, knee, and shoulder arthroplasty in patients with a history of solid organ transplant: A review","volume":"51","author":"Patel","year":"2024","journal-title":"J. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.arth.2021.08.027","article-title":"Increased Medical Complications Following Primary Total Hip Arthroplasty in Patients With Solid Organ Transplant: A Matched Cohort Analysis","volume":"37","author":"Agarwal","year":"2022","journal-title":"J. Arthroplast."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.arth.2011.12.030","article-title":"Outcomes of total hip and knee arthroplasty after cardiac transplantation","volume":"27","author":"Leonard","year":"2012","journal-title":"J. Arthroplast."},{"key":"ref_8","first-page":"720","article-title":"Total hip arthroplasty in heart transplant patients","volume":"73","author":"Resines","year":"2007","journal-title":"Acta Orthop. Belg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jse.2019.05.042","article-title":"Shoulder arthroplasty in patients with immunosuppression following solid organ transplantation","volume":"29","author":"Hatta","year":"2020","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.arth.2015.10.007","article-title":"How Do Previous Solid Organ Transplant Recipients Fare After Primary Total Knee Arthroplasty?","volume":"31","author":"Klement","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.arth.2021.11.029","article-title":"Hip Arthroplasty Outcomes for Femoral Neck Fractures in Transplant Patients","volume":"37","author":"Hsiue","year":"2022","journal-title":"J. Arthroplast."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.1016\/j.arth.2016.04.012","article-title":"Survivorship After Primary Total Hip Arthroplasty in Solid-Organ Transplant Patients","volume":"31","author":"Chalmers","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1007\/s00264-022-05597-6","article-title":"Total joint arthroplasty following solid organ transplants: Complications and mid-term outcomes","volume":"46","author":"Wu","year":"2022","journal-title":"Int. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1007\/s00402-025-05836-6","article-title":"Perioperative complications and mid-term outcomes in total hip and knee joint arthroplasty among solid organ transplant recipients: Lowest reoperation-free survival and patient survivorship in lung transplant recipients","volume":"145","author":"Simon","year":"2025","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/ans.15262","article-title":"Outcomes of total hip arthroplasty surgery in heart and lung transplant recipients","volume":"89","author":"Cosic","year":"2019","journal-title":"ANZ J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.arth.2013.02.005","article-title":"Solid organ transplant patients experience high rates of infection and other complications after total knee arthroplasty","volume":"28","author":"Klatt","year":"2013","journal-title":"J. Arthroplast."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1016\/j.arth.2014.03.027","article-title":"Risk versus reward: Total joint arthroplasty outcomes after various solid organ transplantations","volume":"29","author":"Ledford","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00264-016-3265-5","article-title":"Post-operative medical and surgical complications after primary total joint arthroplasty in solid organ transplant recipients: A case series","volume":"41","author":"Palmisano","year":"2017","journal-title":"Int. Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2548","DOI":"10.1016\/j.jse.2020.03.035","article-title":"Shoulder arthroplasty in solid organ transplant patients: A retrospective, match paired analysis","volume":"29","author":"Rizk","year":"2020","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jcot.2019.07.018","article-title":"Complications of total joint arthroplasty in solid organ transplant patients versus a large control group","volume":"11","author":"Brown","year":"2020","journal-title":"J. Clin. Orthop. Trauma."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"76","DOI":"10.2106\/JBJS.20.00397","article-title":"Outcomes following Total Hip Arthroplasty for Femoral Head Osteonecrosis in Patients with History of Solid Organ Transplant","volume":"104","author":"Quinlan","year":"2022","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.arth.2014.11.037","article-title":"Total Joint Arthroplasty in Transplant Recipients: In-Hospital Adverse Outcomes","volume":"30","author":"Cavanaugh","year":"2015","journal-title":"J. Arthroplast."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.arth.2016.10.017","article-title":"The Impact of Solid Organ Transplant History on Inpatient Complications, Mortality, Length of Stay, and Cost for Primary Total Hip Arthroplasty Admissions in the United States","volume":"32","author":"Navale","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1016\/j.arth.2015.04.044","article-title":"Early Postoperative Outcomes of Primary Total Knee Arthroplasty After Solid Organ Transplantation in the United States, 1998\u20132011","volume":"30","author":"Klika","year":"2015","journal-title":"J. Arthroplast."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/S0140-6736(17)30059-4","article-title":"The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: A population-based cohort study","volume":"389","author":"Bayliss","year":"2017","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"732","DOI":"10.52312\/jdrs.2025.2423","article-title":"Avascular necrosis in kidney transplant recipients: Incidence and risk factors in the modern immunosuppression era","volume":"36","author":"Kumru","year":"2025","journal-title":"Jt. Dis. Relat. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S305","DOI":"10.1016\/j.ajt.2024.01.016","article-title":"OPTN\/SRTR 2022 Annual Data Report: Heart","volume":"24","author":"Colvin","year":"2024","journal-title":"Am. J. Transplant."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Moris, D., and Giorgakis, E. (2025). The New Era of Organ Transplantation in Greece: Time to Converge with the Western World. Transpl. Int., 38.","DOI":"10.3389\/ti.2025.14668"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jor.2022.11.015","article-title":"Shoulder arthroplasty following solid organ transplant: A systematic review and meta-analysis","volume":"35","author":"Patel","year":"2022","journal-title":"J. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2174\/1874325000903010027","article-title":"Joint Arthroplasties other than the Hip in Solid Organ Transplant Recipients","volume":"3","year":"2009","journal-title":"Open Orthop. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"127","DOI":"10.5371\/hp.2022.34.3.127","article-title":"Clinical Outcomes following Primary Hip Replacement Arthroplasties in Patients with Solid Organ Transplantation: A Systematic Review and Meta-Analysis","volume":"34","author":"Kim","year":"2022","journal-title":"Hip Pelvis"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6794\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T04:49:13Z","timestamp":1788583753000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":32,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176794"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176794","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}