Perioperative Medical Management for Patients with RA, SPA, and SLE Undergoing Total Hip and Total Knee Replacement: a Narrative Review

Overview

Journal BMC Rheumatol

Specialty Rheumatology

Date 2019 Mar 20

PMID 30886953

Citations 6

Authors

Susan M Goodman

Anne R Bass

Affiliations

Soon will be listed here.

Abstract

Total hip (THA) and total knee arthroplasty (TKA) are widely used, successful procedures for symptomatic end stage arthritis of the hips or knees, but patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SPA) including ankylosing spondylitis (AS) and psoriatic arthritis (PSA) are at higher risk for adverse events after surgery. Utilization rates of THA and TKA remain high for patients with RA, and rates of arthroplasty have increased for patients with SLE and SPA. However, complications such as infection are increased for patients with SLE, RA, and SPA, most of whom are receiving potent immunosuppressant medications and glucocorticoids at the time of surgery. Patients with SLE and AS are also at increased risk for perioperative cardiac and venous thromboembolism (VTE), while RA patients do not have an increase in perioperative cardiac or VTE risk, despite an overall increase in VTE and cardiac disease. This narrative review will discuss the areas of heightened risk for patients with RA, SLE, and SPA, and the perioperative management strategies currently used to minimize the risks.

Citing Articles

Impact of systemic lupus erythematosus (SLE) on outcomes following aseptic and septic revision total knee arthroplasty: an analysis of the 2005-2018 nationwide inpatient sample.

Zhao G, Huang X, Shi J, Chen J, Chen F, Wei Y Clin Rheumatol. 2024; 43(10):3127-3137.

PMID: 39136835 DOI: 10.1007/s10067-024-07098-w.

Does systemic lupus erythematosus impact the peri-operative complication rates following primary total knee arthroplasty? A national inpatient sample-based large-scale study.

Viswanathan V, Sakthivelnathan V, Senthil T, Menedal A, Purudappa P, Mounasamy V Arch Orthop Trauma Surg. 2022; 143(6):3291-3298.

PMID: 35976411 DOI: 10.1007/s00402-022-04581-4.

Acute surgical site infection after total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis.

Chung H, Wen S, Chang W, Liu K Sci Rep. 2021; 11(1):22704.

PMID: 34811453 PMC: 8609034. DOI: 10.1038/s41598-021-02153-x.

Glucocorticoid-induced osteonecrosis in systemic lupus erythematosus patients.

Kaneko K, Chen H, Kaufman M, Sverdlov I, Stein E, Park-Min K Clin Transl Med. 2021; 11(10):e526.

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Perioperative Management of Patients With Ankylosing Spondylitis Undergoing Spine Surgery.

Zakaryan A, Ginosyan K Front Pharmacol. 2020; 11:1017.

PMID: 32742263 PMC: 7364138. DOI: 10.3389/fphar.2020.01017.

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