Perioperative Management for Total Knee Replacement

Medication Management for Rheumatic Disease Patients

• The American College of Rheumatology recommends continuing methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine at current doses throughout the perioperative period, as this reduces infection risk (RR 0.39, 95% CI 0.17-0.91) and decreases disease flares postoperatively (RR 0.06, 95% CI 0.0-1.10) 1, 2
• The American College of Rheumatology suggests withholding all biologic agents prior to surgery and scheduling the procedure at the end of the dosing cycle for the specific medication, and resuming biologic agents only after wound healing is confirmed (minimum 14 days) and absence of both surgical site and systemic infection is established 2, 4
• The American College of Rheumatology recommends continuing the patient's current daily glucocorticoid dose rather than using "stress-dose" protocols, with optimal preoperative glucocorticoid dosing being <20 mg/day prednisone equivalent when possible, as doses >15 mg/day increase infection risk 5, 6