Table 2 Perioperative precautions relating to arthroplasty in lung transplant patients (adapted from Schuurmans et al. [27])

1

Exhaustion of conservative treatment, interdisciplinary approval of operative treatment, “No standard indications for non-standard patients!”

2

Meticulous preparation of procedure with all involved specialists that may be relevant (including lung transplant specialist, experienced surgeon, specialized anesthetist, experienced intensive care physician for possible postoperative care)

3

Additional intravenous anti-infective treatment for at least one day before and prolonged after arthroplasty

4

Early and consequent laxative treatment to prevent intestinal complications. Avoid opioids.

5

Cautious blood pressure control and accurate fluid management. Arterial hypertension is highly prevalent among lung transplant patients. Preoperatively no restricted fluid intake to avoid hemodynamic instability and renal dysfunction. Fluid overload should be avoided intra-operatively due to impaired lymphatic drainage

6

Low threshold for transfusion postoperatively

7

Strict anti-reflux measures to prevent gastro-esophageal reflux and aspiration

8

Preventive strategies including intensive care unit bed ‘on standby’ after surgery

9

Anticipation of high likelihood of possible complications (kidney failure, hematoma, wound healing disturbance, delirium