OrthoNet

Inflamm. Arthritis
Approach to Inflammatory Arthritis - Preoperative Planning

- includes rheumatoids, SLE, ank spond, psoriatic arthritis

Pre-Operative Considerations

- beware the increased risk of infection: psoriatic arthritis patients have a higher risk of deep infection - probably from skin lesions colonized with bacteria. Rheumatoids also have higher risk of infection
- beware skin ulceration: rheumatoids may have skin vasculitis that makes them prone to ulceration
- beware atlanto-axial and atlanto-occipital instability in rheumatoids - may be asymptomatic in over 50% May also see instability in ank sponds. Does not require fusion - requires careful intubation (awake, fluoroscopic)
- beware limited chest wall expansion in ank sponds or other seronegative arthritides - need preop pulmonary function studies and careful positioning so as to not impede their diaphragmatic breathing
- beware pulmonary disease in rheumatoids - restrictive +/- nodules - need preop pulmonary function
- beware ileitis and colitis when associated with arthritis - increased risk of infection
- beware anemia of chronic disease - almost universal
- beware immune suppression, with and without steroid use
- beware variations in bone quality - rheumatoids have increased bone turnover in periarticular bone - may attribute to high loosening rates; be wary of using cementless fixation in this population
- beware soft tissue contractures and joint DEFORMITY in inflammatory arthritis - be prepared for difficult ligament balancing and soft tissue releases around the knee and hip
- beware the medications that they may be on - NSAIDs, steroids, methotrexate - all should be noted, and arguably stopped in lieu of their surgery