Diseases of the connective tissue are a varied group of disorders with major musculoskeletal manifestations such as joint pain and loss of function. As a consequence of the accompanying inflammatory joint disease, such patients often require surgery. Due to the protean organ-related consequences of these conditions, patients who suffer from chronic connective tissue disease are a highly challenging population in the perioperative context. This paper reviews the management of such patients in this clinical setting.
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Osnes-Ringen H, Kvien TK, Henriksen JE et al. Orthopedic surgery in 255 patients with inflammatory arthropathies: longitudinal effects on pain, physical function and health-related quality of life. Ann Rheum Dis 2009;68:1596-1601.
Jamsen E, Huhtala HH, and T Hoilanen. Risk factors of infection after knee arthroplasty. A register-base analysis of 43,149 cases. J Bone Jt Surg Am 2009;91(1):38-47.
Bongartz T, Halligan CS, Osmon DR, et al. Incidence and risk factors of prosthetic joint infectin after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 2008;59(12):1713-20.
Erkan D, Leibowitz E, Berman J et al. Perioperative Medical Management of Antiphosholipid Syndrome: Hospital for Special Surgery Experience, Review of Literature, and Recommendations. J Rheum 2002;294:843-849.
Scanzello C, Figgie, Nestor BJ et al. Perioperative Management of Medications Used in the Treatment of Rheumatoid Arthritis. HSS Journ 2006;2:141-147.
MacKenzie CR. Perioperative Management of Rheumatoid Arthritis in Patients on Biologics. Cont Topics in RA 2008;2(4):2-5.
Roman MH and J Salmon. Cardiovascular Manifestations of Rheumatologic Disease. Circ 2007;116:2346-2355.
Urowitz MB, Bookman AA, Koehless BE, et al. The Bimodal Mortality Pattern of SLE. Am J Med 1976;60:221-5.
Manzi S, Meilahn EN, Raurie JE, et al. Age specific incidence rate of MI and angina in woman with SLE: Comparison with the Framingham study. Am J Epi 1997;145:408-415.
Coblyn J and PT O’Gara (2003) The heart in rheumatic disease. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, and MH Weisman (eds) Rheumatology, 3rd ed. Mosby Elsevier, Toronto
Fleisher LA, Beckman JA, Brown KA et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2007;50:159-242.
Kwon E, Fleisher LA and K Eagle. Cardiac Risk Assessment in Noncardiac Surgery. In: Perioperative Medicine: Managing for Outcome. Newman MF, Fleisher LA and MP Fink. Sanders Elsevier, Philadelphia 2008.
Halm W, Browner WS, Tubau JF, et al. Echocardiography for assessing cardiac risk in patients having noncardiac surgery. Study of Perioperative Ischemia Research Group. Ann Int Med 1996;125:433-441.
Mangano DT, Layug B, Tateo I, et al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Eng J Med 1996;335:1713-1720.
Devereaux PJ,,Yang H, Yusuf S, et al. POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial. Lancet 2008;371:1839-1847.-
Bennet SJ, Berry OM, Goddard J, et al. Acute renal dysfunction following hip fracture. Injury 2010; 41:335–338.
Marker GA, Brodner W, Giurea A, et al. Long-term follow-up of metal-on-metal total hip replacement. J Orthop Res 2007;25(7):841-848.
Sharrock NE, Beksac B, Flynn E, et al. Hypotensive epidural anaesethesia in patients with preoperative renal dysfunction undergoing total hip replacement. Br J Anaesth 2006;96(2):207-212.
Grubl A, Marker W, Giurea BS, et al. Long-term follow-up of metal-on-metal total hip replacement. J Orthop Res 2007;25(7):841–48.
Ramakrishna G, Sprung J, Ravi BS et al. Impact of Pulmonary Hypertension on the Outcome of Noncardiac Surgery. Predictors of Perioperative Morbidity and Mortality. J Am Coll Card 2005;45:1691-1699.
McGlothlin D and T De Marco. Preoperative Risk Assessment of Pulmonary Arterial Hypertension Patients Undergoing General Surgery. Advan Pulm Hyperten 2007;6
Parisi MD, Koval K, Egoi K. Fat embolism syndrome. Am J Ortho 1990;507–512.
Sierra RJ, Trousdale RT and ME Cabanela. Pregnancy and childbirth after total hip arthroplasty. J Bone Joint Surg 2005;87(1):21-4.
Feinberg MR, Capello WN and AJ Detterline. Clinical outcome and incidence of pregnancy after bipolar and total hip arthroplasty in young woman. J Arthroplasty 2003;18(7):879-85.
Bordini SS, De Clerico M and TA Toni. Safetly of pregnancy and delivery after total hip arthroplasty. J Womens Health (Larchmt) 2007;16(9):1300-4.
Ziaee H, Daniel J, Dutta AK, et al. Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty..J Bone Joint Arthroplasty 2007;89-b(3):301305.
Grennan DM, Gray J, Loundon J,et al. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Ann Rheum Dis 2001;60:214-17.
Fuerst M, Mohl H, Baumgartel, et al. Leflunomide increases the risk of early healing complications in patients with rheumatoid arthritis underoing elective orthopedic surgery. Rheum Int 2006;26(12):1138-42.
Tanaka N, Sakahashi H, sato E, et al. Examination of the risk of continuous leflunomide treatment on the incidence of infectious complications after joint arthroplasty in patients with patients with rheumatoid arthritis. J Clin Rheum 2003;9(2):115-8.
Bibbo C, Goldberg JW. Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy. Foot Ankle Int 2004;25(5):331-335.
Giles JT, Bartlett SJ, Gelber AC, et al. Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arthritis. Arthritis Rheum 2006;55(2): 333-335
Marchal L, D’Haens G, van Assche G, et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Ailment Pharmacol Ther 1996;19:749-54.
Pham T, Claudepierre P, Deprez X, et al. Anti-TNF alpha therapy and safety monitoring. Clinical tool guide elaborated by the Club Rhumatismes et Inflammations (CRI), section of the French Society of Rheumatology (SFR). Joint Bone Spine 2005;72(Suppl):1-58.
Ledingham J, Deighton C. British Society for Rheumatology Standards, Guidelines and Audit Working Group (SGWAG) Update on the British Society for Rheumatology guidelines for prescribing TNR-alpha blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001). Rheumatol 2001;44(2):157-163.
Bromberg JS, Alfrey EJ, Barker CF, et al. Adrenal suppression and steroid supplementation in renal transplant recipients. Transplant 1991;51:123-129.
Glowniak JV, Loriaux DL. A double-blind study of perioperative steroid requirements in secondary adrenal insufficiency. Surgery 1997;121:123-29.
Leopold SS, Casnellie MT, Warme WJ, et al. Endogenous cortisol production in response to knee arthroscopy and total knee arthroplasty. J Bone JT Surg Am 2003;85A:2163-67.
Willis AA, Warren RF, Craig EV, et al. Deep-Vein Thrombosis Following Reconstructive Shoulder Arthroplasty. HSS Alumni Day Presentation 2004.
Westrich GH, Weksler BB, Glueck CJ, et al. Correlation of Thrombophilia and Hypofibrinolysis with Pulmonary Embolism Following Total Hip Arthroplasty. J Bone Jt Surg Am 2002;84:2161-67.
Della Valle AG, Serota A, Go G, et al. VTE is Rare with a Multi-modal Prophylaxis Protocol after THA. Clin Ortho Rel Research 2006;444:146-153.
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Goodman, S.M., Figgie, M.P. & MacKenzie, C.R. Perioperative Management of Patients with Connective Tissue Disease. HSS Jrnl 7, 72–79 (2011). https://doi.org/10.1007/s11420-010-9180-1
- connective tissue disease
- perioperative care