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Patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH) are at increased risk when undergoing anesthesia and major surgery. Data on outcomes for elective orthopedic surgery in patients with PH are limited. A patient pathway was established to provide access to elective lower limb arthroplasty. This included assessment of orthopedic needs, fitness for anesthesia, preoperative optimization, and intra‐ and postoperative management. Patient data were retrospectively retrieved using patient's hospital records. Between 2012 and 2020, 29 operations (21 total hip replacements [THRs], 7 total knee replacements [TKRs], 1 total hip revision) were performed in 25 patients (mean age: 67 years). Perioperatively, 72% were treated with low‐dose intravenous prostanoid. All had arterial lines, and central access and perioperative lithium dilution cardiac output monitoring was used in 86% of cases. Four patients underwent GA, 21 spinal anesthesia, and 4 CSE anesthesia. Supplemental nerve blocks were performed in all patients undergoing general, and 12 of 21 undergoing spinal anesthesia. All were managed in high dependency postoperatively. Hospital length of stay and complication rates were higher than reported in non‐PH patients. Perioperative complications included hypotension requiring vasopressors (n = 10), blood transfusion (n = 7), nonorthopedic infection (n = 4), and decompensated right heart failure (n = 1). There was no associated mortality. All implants were functioning well at 6 weeks and subsequent follow‐up. EmPHasis‐10 quality of score decreased by 5.5 (±2.1) (p = 0.04). A dedicated multiprofessional pathway can be used to safely select and manage patients with PH through elective lower limb arthroplasty.

This study reviews the clinical and radiographic results of 207 consecutive noncemented Tricon-M (Smith & Nephew Ine, Memphis, Tenn) total knee replacements (TKRs) in 1 89 patients. The patella was surfaced in 1 1 9 cases, and mean follow-up was 8 years (range: 4-10 years). At final follow-up, mean Hospital for Special Surgery score improved 45 points in 187 cases. Survivorship, with failure defined as the need for revision, was 98% at 4 years, 97% at 7 years, 94% at 8 years, and 90% at 10 years. Twenty-one (11.3%) patients went on to revision. Results for overweight and obese patients did not differ significantly from normalweight patients. The noncemented Tricon-M TKR prosthesis yields acceptable results; however, patella surfacing and the use of a tibial polyethylene insert ≥12 mm thick are recommended.

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