#2-61E. Optimizing TAA Outcomes: Perioperative DMARD Management in Severe RA (JCM, 2025)

When performing total ankle arthroplasty (TAA) for patients with severe rheumatoid arthritis (RA), a major clinical challenge is managing the high risk of postoperative complications, particularly compromised wound healing, linked to chronic immunosuppressive therapy. This retrospective study compared early outcomes in 34 end-stage RA patients undergoing TAA, evaluating the effect of perioperative anti-rheumatic medication modification, including DMARDs and biologics, based on established total hip and knee arthroplasty guidelines. The most significant finding reveals that standardized perioperative medication modification significantly improved wound healing (lower ASEPSIS scores) up to four weeks postoperatively and eliminated delayed wound healing (>4 weeks), compared to the uncontrolled group (25% rate). This suggests a concrete strategy for mitigating early complications. However, practitioners must acknowledge the study’s limitations as a small, non-randomized retrospective cohort, which introduces potential selection and temporal biases. Given the lack of specific guidelines for TAA, these results offer crucial clinical implications for orthopedic surgeons and rheumatologists seeking to proactively manage and reduce early wound complication risks in RA patients undergoing this increasingly common procedure.

Citation: Yi, J.W.; Kim, S.-H.; Bang, S.-M.; Cho, B.-K. The Effect of the Modification of Perioperative Anti-Rheumatic Medications on Early Complications After Total Ankle Arthroplasty for Severe Rheumatoid Arthritis. J. Clin. Med. 2025. DOI: 10.3390/jcm14207280

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