Total Joint Arthroplasty in Patients with Inflammatory Rheumatic Diseases

Abstract

Since its introduction, total joint arthroplasty (TJA) has improved the quality of life of patients with degenerative joint disorders. In the last decades, a number of conventional and biological disease-modifying antirheumatic drugs have become available for the treatment of patients with inflammatory rheumatic diseases (IRD), leading to a reduction in the need to undergo TJA. However, TJA is still frequently performed in IRD patients. Both rheumatologists and orthopedics should be aware that patients with IRD have a peculiar perioperative risk profile due to disease-related, patient-related, and surgery-related risk factors. On the basis of current evidence, TJA is a safe procedure for IRD patients as long as an accurate risk stratification and a multidisciplinary approach are applied. We here describe the current strategies for an appropriate surgical management of osteoarthritis in IRD patients and the fascinating opening perspectives that surgeons and clinicians may expect in the future.

Keywords: Inflammatory rheumatic diseases; Psoriatic arthritis; Rheumatoid arthritis; Rheumatology; Systemic lupus erythematosus; Total joint arthroplasty.

Fig. 1

Timeline of the main discoveries and inventions in orthopedics and rheumatology in the nineteenth and twentieth century. FDA Food and Drug Administration, RA rheumatoid arthritis, SLE systemic lupus erythematosus, TNF tumor necrosis factor. Modified from Mocsai et al. (2014) with permission [43]