# The Effect of the Modification of Perioperative Anti-Rheumatic Medications on Early Complications After Total Ankle Arthroplasty for Severe Rheumatoid Arthritis

## TL;DR

Modifying anti-rheumatic medications before and after ankle surgery for severe rheumatoid arthritis helps reduce early wound complications.

## Contribution

This study shows that following a medication modification guideline reduces early wound complications after ankle surgery for RA patients.

## Key findings

- Modified medication groups had better wound healing scores up to 4 weeks post-surgery.
- Delayed wound healing occurred in 25% of the uncontrolled group but none in the controlled group.
- No significant differences in radiological complications or reoperation rates between groups.

## Abstract

Background/Objectives: The potential risk of postoperative complications related to chronic inflammation and immunosuppressive therapy is still an ongoing concern for patients with rheumatoid arthritis (RA). This retrospective comparative study reports the outcomes, including early complications after total ankle arthroplasty (TAA), for end-stage RA, and the effects of the modification of perioperative anti-rheumatic medications. Methods: A total of 18 patients (the controlled group) with and 16 (the uncontrolled group) without the modification of perioperative anti-rheumatic medications (according to an established guideline used in total hip and knee arthroplasty) were followed for 2 years after three component mobile-bearing TAA. Clinical evaluations consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) scores, the Foot and Ankle Outcome Score (FAOS), and the ASEPSIS score for wound assessment. Additionally, clinical and radiological complications, and reoperation rates were investigated. Results: In the postoperative follow-up evaluation at 2 years, there were no significant differences in the AOFAS and FAOS scores between the two groups. In postoperative wound monitoring, using the ASEPSIS scoring system, the controlled group demonstrated the better wound healing up to 4 weeks postoperatively, compared to the uncontrolled group (3.1 vs. 6.8 points, p = 0.003). In terms of early postoperative complications, there was a significant difference in delayed wound healing rates between the two groups (0 vs. 25%, p = 0.039). Up to 2 years postoperatively, there were no significant differences in the radiological complications and reoperation rates between the two groups. Conclusions: In TAA for end-stage RA, the modification of perioperative anti-rheumatic medications based on the specified guideline appears to be one of the effective solutions to reduce early postoperative wound complication.