Total Knee Arthroplasty Considerations in Rheumatoid Arthritis

Table 1

Disease-modifying antirheumatic drugs (DMARDs) dosing regimen in the perioperative period. The preoperative withholding period prior to surgery is specified as well as the waiting period postoperatively prior to reinstituting the medication.

Agent	Preoperative hold	Postoperative restart
Methotrexate∧ [15, 16]	No hold	No hold
Leflunomide [5]	1-2 days	1-2 weeks
Sulfasalazine [5]	1 day	3 days
Hydroxychloroquine [5]	No hold	No hold
Etanercept [10, 17]	1 wk	10–14 days
Infliximab [10, 17]	End dose cycle	10–14 days
Adalimumab [10, 17]	End dose cycle	10–14 days
Anakinra [10]	1-2 days	10 days

∧In patients with normal renal function, methotrexate should be continued throughout the preoperative/postoperative period. If renal function is abnormal, the medication should be held 1 week prior to surgery and restarted 1-2 weeks postoperatively, after the immediate stresses of surgery have subsided.