Nothing new today. The sweep found no new device approvals, recalls, safety communications or guideline releases relevant to orthopaedics, and the regulatory feeds returned no orthopaedic items at all.
The most useful recent evidence bearing on a routine perioperative decision is a synthesis of 67 studies covering 51,394 patients on whether to continue or withhold biologic and targeted synthetic disease-modifying antirheumatic drugs around orthopaedic surgery. It quantifies both sides of a trade-off usually argued from principle. Continuing these drugs was associated with increased surgical site infection (corrected odds ratio 1.27, 95% CI 1.12 to 1.44) and a non-significant trend towards more prosthetic joint infection (1.24, 0.88 to 1.75). Withholding them raised disease flare substantially — continuation reduced flare risk with an odds ratio of 0.41 (0.29 to 0.58).
There is one further point worth carrying into the perioperative assessment. Continuation was associated with lower CRP and interleukin-6 in the perioperative period, which means these drugs suppress the very markers used to detect early infection. A patient who continued a biologic and develops a postoperative infection may not mount the CRP rise you are watching for.
The practical position is individualisation, which is what the existing rheumatology guidance already says — but now with numbers. Roughly, withholding trades a flare risk of the order of two-and-a-half-fold for an infection risk reduction of about a quarter. For elective arthroplasty in a patient with quiescent disease, withholding is easily justified; for a patient whose disease flares badly and fast, less so. Make the decision jointly with the rheumatologist rather than unilaterally, and record which way it went and why.
- No new orthopaedic device approvals, recalls or guideline releases today.
- Withholding biologic or targeted DMARDs perioperatively cuts infection risk by about a quarter and roughly doubles flare risk.
- Decide jointly with the rheumatologist and record the reasoning in the operation note.
- Remember these drugs suppress CRP and interleukin-6, blunting the early signal of postoperative infection.
- Favour withholding for elective arthroplasty in quiescent disease; individualise where flares are severe.
The statistics, in plain English
This synthesis pooled randomised and observational studies, so confounding by indication applies: surgeons and rheumatologists withhold these drugs from patients they judge to be at higher infection risk, and continue them in patients whose disease is more aggressive. That works against detecting the very effects reported, which makes the infection signal more credible than the raw design suggests. The prosthetic joint infection estimate, with an interval of 0.88 to 1.75, is genuinely inconclusive — pointing towards harm but compatible with none, because prosthetic infections are rare enough that even 51,394 patients yield relatively few events.
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