Total Joint Arthroplasty During Ramadan: Perioperative Implications for Patients and Surgeons.

Total joint arthroplasty (TJA) is increasingly performed in a global patient population that includes individuals observing prolonged daily fasting during Ramadan, a lunar calendar-based observance occurring over 29 to 30 consecutive days. Daily fasting may exceed 14 to 18 hours depending on geography and season, producing measurable alterations in hydration, glycemic variability, circadian rhythm, and sleep architecture that intersect with perioperative safety in TJA. This article synthesizes the physiologic and perioperative considerations, examines the implications for patients and surgeons, and proposes a framework for risk stratification, shared decision-making, and perioperative management. Elective TJA during Ramadan is not inherently contraindicated but requires structured assessment, perioperative planning, and patient counseling.