Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview

Figures

• 

  Fig. 1. Management of synthetic and biological disease-modifying anti-rheumatic drugs in patients with inflammatory rheumatic diseases undergoing total hip or knee arthroplasty. DMARD disease-modifying anti-rheumatic drugs, SLE systemic lupus erythematosus. *No evidence, in high-risk patients suspend 3 days before surgery

• 

  Fig. 2. Management of antiplatelet agents in patients with inflammatory rheumatic diseases undergoing total hip or knee arthroplasty. ASAP as soon as possible, BMS bare metal stent, CAD coronary artery disease, DAPT double anti-platelet therapy, DES drug-eluted stent, P2Y12I platelet P2Y12 receptor inhibitor

• 

  Fig. 3. Perioperative approach to the patient with inflammatory rheumatic disease and venous thromboembolic risk undergoing total hip or knee arthroplasty. aPL anti-phospholipid, LA lupus anticoagulant, APS anti-phospholipid syndrome, VTE venous thromboembolism, LMWH low molecular weight heparin, UFH unfractionated heparin. *Additional risk factors for VTE: arterial hypertension, obesity, diabetes mellitus, smoking, neoplasia, oral contraceptives, underlying inflammatory joint disease, genetic hypercoagulable state; §avoid anti-embolism stockings in suspected or proven peripheral arterial disease, peripheral arterial bypass grafting, peripheral neuropathy or other causes of sensory impairment, any local conditions in which stockings may cause damage, for example fragile ‘tissue paper’ skin, dermatitis, gangrene or recent skin graft, use caution and clinical judgement when applying anti-embolism stockings over venous ulcers or wounds. https://www.nice.org.uk/guidance/cg92/chapter/1-Recommendations#using-vte-prophylaxis