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

Goodman, Susan M.; Bass, Anne R.

doi:10.1186/s41927-018-0008-9

Cited by 23 publications

(15 citation statements)

References 95 publications

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“…We found that SS was not associated with complications including implant infection, revision or mortality after primary THA or TKA. Our nding contrasts with previously noted higher post-TKA/THA complication rates in people with other systemic in ammatory conditions, such as RA, SpA or lupus (5). Limited joint or organ involvement in SS compared to RA, SpA or lupus (20) and/or the assessment of in-hospital complications in our study (vs. all post-operative complications) may explain these differences.…”

Section: Discussioncontrasting

confidence: 99%

“…Total knee arthroplasty (TKA) or hip arthroplasty (THA) are the two most common arthroplasty surgeries performed for end-stage arthritis (4). Complications and healthcare utilization after arthroplasty are increased in other systemic in ammatory rheumatic disease such as RA, lupus and spondyloarthritis (5). Whether SS, which is also a systemic autoimmune disease, has a similar impact on post-arthroplasty outcomes is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

Singh

Cleveland

2020

Preprint

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Objective: To assess whether Sjogren’s Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA). Methods: We used the 1998-2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region . Results: We examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998-2014; 12,772 (0.2%) primary TKAs and 6,222 (0.2%) primary THAs were done in people with SS. In multivariable-adjusted models, SS was associated with a statistically significant higher odds ratio (OR; 95% confidence interval (CI)) of discharge to a rehabilitation/inpatient facility post-THA, 1.13 (1.00, 1.28), but not post-TKA, 0.93 (0.86, 1.02). We noted no differences in the length of hospital stay or hospital charges. SS was associated with significantly higher adjusted odds of in-hospital transfusion post-THA, 1.37 (1.22, 1.55) and post-TKA, 1.21 (1.10, 1.34). No significant differences by SS diagnosis were seen in hospital stay, hospital charges implant infection, implant revision or mortality rates. Conclusions: People with SS had higher transfusion rate post-TKA/THA, and higher rate of discharge to non-home setting post-THA. The lack of association of SS with post-arthroplasty complications should reassure patients, surgeons and policy-makers about the utility of TKA/THA in people with SS undergoing these procedures.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

Singh

Cleveland

2020

Preprint

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“…Total joint arthroplasty in patients with rheumatic diseases should be performed after a multidisciplinary team consensus regarding the medication adjustment, to reduce the overall complication rate [4].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with RA, SPA and SLE are at higher risk of venous thromboembolism (VTE) compared to general population [4,24]. There is an association between inflammation and thrombosis, that is why rheumatic disorders should be controlled before the surgery [4,25].…”

Section: Complicationsmentioning

confidence: 99%

“…In the past decades, rates of arthroplasty for patients with SPA have risen by 50%, for patients with SLE by 100% and for patients with RA have remained stable [4,5]. Orthopedic surgery for inflammatory arthritis may not be equivalent to patients with osteoarthritis due to joint deformities, bone loss and immunomodulatory medication [2,6,7].…”

Section: Introductionmentioning

confidence: 99%

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Medical management of patients with inflammatory arthritis undergoing total hip arthroplasty and total knee arthroplasty

Crețu

Bojincă

Milicescu

et al. 2019

Romanian Journal of Orthopaedic Surgery and Traumatology

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Total joint arthroplasty (TJA) including total hip arthroplasty (THA) and total knee arthroplasty (TKA) are performed for patients with primary osteoarthritis (OA). Also, there are patients who undergo TJA for management of inflammatory arthritis (IA), including patients with rheumatoid arthritis (RA), Spondyloarthritis (SPA) including ankylosing spondylitis (AS) and psoriatic arthritis (PSA) and systemic lupus erythematosus (SLE).The purpose of this review was to evaluate the current knowledge about the risk of complications after TJA in patients with IA and perioperative management of antirheumatic drugs.THA and TKA are orthopedic surgeries that help patients with arthritis restore function, mobility and reduce pain. Patients with inflammatory arthritis have systemic disorders that cause a high rate of complications associated with the surgery.Patients with inflammatory arthritis, including RA, SPA, and SLE who need TJA have a higher risk of developing complications compared to patients with OA.Information about cardiovascular risk factors and other comorbidities is important to better control and reduce the risk of postoperative complications.AbbreviationsTJA = total joint arthroplasty, THA = total hip arthroplasty, TKA = total knee arthroplasty, OA = osteoarthritis, SPA = spondyloarthritis, IA = inflammatory arthritis, RA = rheumatoid arthritis, AS = ankylosing spondylitis, PSA = psoriatic arthritis, SLE = systemic lupus erythematosus, DMARDs = Disease-modifying antirheumatic drugs, PJI = prosthetic joint infection, VTE = venous thromboembolism, HCQ = hydroxychloroquine, SSZ = sulfasalazine, TNF = tumor necrosis factor, GS = corticosteroids.

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Glucocorticoid‐induced osteonecrosis in systemic lupus erythematosus patients

Kaneko

Chen

Kaufman

et al. 2021

Clinical & Translational Med

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Osteonecrosis (ON) is a complex and multifactorial complication of systemic lupus erythematosus (SLE). ON is a devastating condition that causes severe pain and compromises the quality of life. The prevalence of ON in SLE patients is variable, ranging from 1.7% to 52%. However, the pathophysiology and risk factors for ON in patients with SLE have not yet been fully determined. Several mechanisms for SLE patients’ propensity to develop ON have been proposed. Glucocorticoid is a widely used therapeutic option for SLE patients and high‐dose glucocorticoid therapy in SLE patients is strongly associated with the development of ON. Although the hips and knees are the most commonly affected areas, it may be present at multiple anatomical locations. Clinically, ON often remains undetected until patients feel discomfort and pain at specific sites at which point the process of bone death is already advanced. However, strategies for prevention and options for treatment are limited. Here, we review the epidemiology, risk factors, diagnosis, and treatment options for glucocorticoid‐induced ON, with a specific focus on patients with SLE.

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

Cited by 23 publications

References 95 publications

Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

Medical management of patients with inflammatory arthritis undergoing total hip arthroplasty and total knee arthroplasty

Glucocorticoid‐induced osteonecrosis in systemic lupus erythematosus patients

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