What is the most common surgical complication for patients with rheumatoid arthritis undergoing foot surgery?

• A. Delayed wound healing
• B. Infection
• C. Nonunion
• D. Hardware loosening

Answer: (A)

In rheumatoid arthritis, soft-tissue healing is often impaired by the combination of chronic inflammation and long-term immunosuppressive therapy, especially corticosteroids. Steroids thin and fragilize skin, slow collagen synthesis, reduce fibroblast activity, and blunt new blood vessel formation, all of which slow the normal wound-healing cascade. The foot presents additional challenges: incisions go through thin, sometimes edematous skin with relatively limited soft-tissue coverage, increasing the likelihood that a wound takes longer to close or dehisces. Although infection, nonunion, and hardware loosening can occur more readily in RA, delayed wound healing is the most common complication after foot surgery in these patients because the soft-tissue healing process is consistently compromised. Strategies to mitigate this include optimizing disease control, minimizing unnecessary steroid exposure when possible, meticulous soft-tissue handling, and ensuring good nutrition and local wound care.