Arthroplasty in patients with established rheumatoid arthritis (RA): Mitigating risks and optimizing outcomes

Patients with rheumatoid arthritis (RA) continue to undergo arthroplasty to relieve pain and restore lost function caused by joint damage, despite improvements in disease-modifying therapy. The widespread use of potent immunosuppressant medications by RA patients implies that they frequently receive these drugs at the time of surgery. In addition to the medical challenges of medication and disease management at the time of surgery, there are surgical complexities related to complex deformities, osteoporotic bone, and ligament laxity. This paper discusses the current state of the art regarding arthroplasty utilization, outcomes, and perioperative management from a medical and surgical perspective, and highlights the clinical challenges to achieve optimal outcomes.