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.  The etiology of the disease remains unclear, but there are strong associations with human leukocyte antigens (DRB1).  The prognosis is poor, with 80% of patients being disabled 20 years from primary diagnosis.  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.  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. 
Seventeen percent of patients with RA undergo an orthopaedic intervention within 5 years of initial diagnosis.  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).  This review article summarizes factors involved in the perioperative management of major lower limb arthroplasty surgery for patients with RA.
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