Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review

BMC Rheumatology

Anne R. Bass¹  Susan M. Goodman¹ 

[1] Department of Medicine, Weill Cornell Medical School, Division of Rheumatology Hospital for Special Surgery, New York City, USA

关键词: Total hip arthroplasty;    Total knee arthroplasty;    Rheumatoid arthritis;    Systemic lupus erythematosus;    Spondyloarthritis;    Perioperative infection;    Cardiac risk;    Venous-thromboembolism;   

DOI  :  10.1186/s41927-018-0008-9

学科分类：内科医学

来源: BioMed Central

【 摘 要 】

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.

【 授权许可】

CC BY