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Do antitumor necrosis factor agents increase the risk of postoperative orthopedic infections?

Purpose of reviewPatients with rheumatoid arthritis and other inflammatory arthritides treated with tumor necrosis factor inhibitors frequently undergo orthopedic procedures. These patients may be at risk for serious postoperative infections as antitumor necrosis factor agents may be associated with impaired immunity against usual and opportunistic pathogens. Recent findingsInformation regarding the influence of tumor necrosis factor inhibitors on the risk for postoperative orthopedic complications is limited, contradictory and solely based on retrospective studies. Basic science derived data seem to only add to the confusion. SummaryThe practitioner is at a loss whenever a decision regarding the perioperative handling of antitumor necrosis factor agents has to be made. An attempt to combine, reconcile, and expand the knowledge available in the current literature will be made.