Lower Limb Joint Replacement in Patients with Rheumatoid Arthritis - Perioperative management considerations for patients with RA who need a total hip, knee, or ankle replacement

Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease, and it is the third most common indication for lower limb joint replacement in Northern Europe and North America. [1] The etiology of the disease remains unclear, but there are strong associations with human leukocyte antigens (DRB1). [2] The prognosis is poor, with 80% of patients being disabled 20 years from primary diagnosis. [3] The medical treatment of RA has improved during the last 25 years, which is reflected by a 40% decrease in the rate of hip and knee surgery since a peak that was observed in the mid 1990s. [4] Anemia, raised erythrocyte sedimentation rate, and a high disease activity score have all been identified as risk factors for the need for large joint arthroplasty. [5] Seventeen percent of patients with RA undergo an orthopaedic intervention within 5 years of initial diagnosis. [5] More than one third of patients will need a major joint replacement, of which the majority will receive a total hip or knee replacement (THR, TKR). [4]  This review article summarizes factors involved in the perioperative management of major lower limb arthroplasty surgery for patients with RA.