Perioperative Management of Biologics in RA Patients Undergoing Knee Replacement

Introduction to Perioperative Management

• The American College of Rheumatology/American Association of Hip and Knee Surgeons conditionally recommends withholding all biologic agents, including Humira, prior to surgery and planning the surgery at the end of the dosing cycle for that specific medication 1

Preoperative and Postoperative Care

• Pre-operative management involves withholding Humira before knee replacement surgery, with surgery timed at the end of the dosing cycle (every 2 weeks for standard dosing) 2, 3, 4
• Post-operative management involves restarting Humira once the wound shows evidence of healing, typically around 14 days post-operatively 1

Rationale for Perioperative Management

• Biologic agents increase the risk of serious infections, with most risk ratios approximately 1.5-fold, and patients with RA undergoing total joint arthroplasty have a nearly 2-fold increased risk of postoperative infection complications 2, 4, 5

Monitoring and Restarting Biologics

• After knee replacement, monitor for wound healing, infection signs, and restart Humira typically 14 days post-operatively when wound healing criteria are met 1
• The American College of Rheumatology recommends monitoring for signs of infection, such as fever, increasing pain, wound drainage, or systemic symptoms, before restarting Humira 1

Avoiding Common Pitfalls

• Do not restart Humira prematurely before adequate wound healing, as this increases infection risk 1
• Do not continue withholding Humira indefinitely after appropriate wound healing, as this increases the risk of RA flare without reducing infection risk 1, 2