Transplant Medications and Their Effects on Wound Healing in Orthopaedic Surgery

Transplant medications are an indispensable component of treatment for patients with autoimmune diseases, malignancy, or solid organ transplants. These immunosuppressive agents, although life preserving, create unique challenges when patients require orthopaedic surgery. With increased survival rates, immunosuppressed transplant patients frequently require orthopaedic intervention, with approximately 5% developing osteonecrosis, 15% to 20% experiencing osteoporotic fractures, and many developing degenerative joint disease necessitating arthroplasty or reconstructive procedures. By inhibiting inflammatory responses, decreasing collagen synthesis, reducing angiogenesis, and impairing cellular proliferation, transplant medications compromise normal immune function and wound healing processes. This physiological interference leads to elevated risks of surgical site infections, wound dehiscence, delayed union, and implant failure-complications resulting in prolonged hospitalization and poorer functional outcomes. Perioperative management becomes even more complex because of the two to fourfold higher incidence of malignancy in long-term immunosuppressed patients, with orthopaedic surgeons frequently treating individuals on both immunosuppressive and antineoplastic therapies. Despite the growing prevalence of orthopaedic procedures in this population, comprehensive guidance on perioperative wound healing management remains fragmented across the literature. This review systematically examines how transplant medications interfere with tissue repair mechanisms and provides evidence-based recommendations for perioperative medication adjustment to optimize surgical outcomes in this high-risk patient group.