Total Joint Arthroplasties in Transgender Patients: Unique Considerations for an Emerging Patient Population

Currently, no studies exist on transgender patients undergoing orthopaedic procedures within the orthopaedic literature at large. This echoes a trend within medicine in general, where despite their unique characteristics, transgender patients are largely ignored in medical research. As gender reassignment surgery becomes more commonplace and these patients' age into joint arthroplasties, orthopaedic surgeons will rapidly be faced with treating this patient group. Unique considerations include medical comorbidities commonly associated with the patient population, deep vein thrombosis risk while on cross-gender hormone therapy, surgical positioning considerations, and social support implications after surgery. In addition, risk reductions for possible future gender reassignment surgeries include consideration for extended perioperative antibiotics and diligent surveillance for implant ingrowth issues. An emphasis is placed on being comfortable with transgender patients to ensure equal access to health care while ensuring understanding and accuracy in describing the risks of surgery that are unique to this patient population.