Rheumatoid Arthritis for Total Hip Replacement

You are in the preadmission assessment clinic. A 77-year-old woman with joint pain presents for assessment prior to an elective right total hip replacement. Past Medical History Hypertension Paroxysmal atrial fibrillation Peripheral vascular disease (bilateral femoral arterial stents inserted in 2018) Rheumatoid arthritis Medications Amlodipine 5 mg once daily Metoprolol 50 mg twice a day Digoxin 125 mcg once daily Apixaban 5 mg twice a day Clopidogrel 75 mg daily Methotrexate 50 mg weekly Quinapril 20 mg once daily Buprenorphine 10 mg patch (10 mcg/hr) Observations Height 145 cm Weight 44.5 kg Body Mass Index 21 kg/m2 She ambulates with a single stick forearm frame and needs help with daily activities such as washing, ironing and cleaning. Photograph of patient's hands showing musculoskeletal changes associated with RA Available investigations: C-spine X ray ECG Biochemistry Full blood count Spirometry