Tocilizumab use during Covid-19 should alert an orthopaedic surgeon for the surgical management of arthroplasty patients: A narrative review

Abstract

The crisis of Covid-19 has shaken the world healthcare systems. The intensive care resources to manage the medical conditions associated with Covid-19 are consistently found to be inadequate with exploration and implementation of newer treatment avenues for an early recovery. Presently, the use of Tocilizumab (TCZ) in severe to critical affection of Covid-19 is being practiced as an off-label therapy. A narrative review of present knowledge regarding TCZ pharmacology, indications of its use, and potential side effects with clinical implications for an orthopedic surgeon is presented. The article discusses the clinicopathological factors required to be monitored during the perioperative management of an orthopedic patient who may have received TCZ for Covid-19 related illness. The implications of its usage should alert the orthopaedic surgeons for future management of their arthritic surgical patients. The commonly associated side effects and complications in the post-operative phase following an arthroplasty or any orthopaedic surgery are an area of concern and considerable uncertainty. In the post-Covid-19 recovery phase, when surgeons need to plan a surgical intervention then a thorough evaluation of their Covid-19 medical management history may be warranted. Practical guidelines for the management of arthritic surgical patients have been postulated. With an unregulated increased usage of TCZ during Covid-19 management, an orthopaedic surgeon should worry and needs to be aware of the possible consequences in the perioperative period for the post-surgery management. Future research to gain more insights will confirm the implied concerns.