Left ventricular assist devices (LVADs) augment the cardiac function of patients with severe left-sided cardiac disease. These devices are typically used as a bridge to transplantation and have proven effective at improving longevity and overall quality of life1. Improved longevity results in increased numbers of noncardiac surgical procedures for other medical conditions2. Although these procedures carry obvious risk, they have been performed with favorable outcomes1-6. Infection is of utmost concern with noncardiac surgery in a patient with an LVAD. While infection rates have improved with the use of second-generation LVADs, the infection rate remains at 30% to 50%, with 20% to 27% classified as bloodstream infections7. The concerns regarding infection are especially important with arthroplasty procedures because implants are susceptible to biofilms, and complications from infection can be devastating. Also of concern is the nonpulsatile flow that the LVADs deliver, which can have serious implications when a patient is under general anesthesia and placed in the lateral position because preload and systemic vascular resistance are affected. Despite these risks, a literature search revealed two total knee arthroplasties that were performed in patients with LVADs4. Both patients developed postoperative infections related to the LVAD, but neither total knee arthroplasty became infected. In terms of cardiac function, total hip arthroplasty has been shown to be extremely effective at playing a role in improving cardiac function, with postarthroplasty patients showing substantial improvements in exercise duration, maximum workload, peak oxygen consumption, and percentage of predicted maximum oxygen uptake achieved by six months postsurgery8. We present a case of a total hip arthroplasty in a patient with a HeartMate II LVAD (Thoratec Corporation, Pleasanton, California). To the best of our knowledge, there are no previous reports in the literature of a …