Identification of high-risk groups for complication after arthroplasty: predictive value of patient’s related risk factors

Abstract

BackgroundTotal joint arthroplasty (TJA) benefit patients with osteoarthritis (OA) and rheumatoid arthritis (RA). However, a specific approach to detect patients at higher risk of prosthetic joint infection (PJI) and mechanical complications is absent. The aim of this study is to identify groups at higher risk for infections and mechanical complications after TJA in patients with RA and OA based on their most significant predictors.MethodsThis is a hospital-based cohort study with 1150 recipients of TJA. Risk factors and comorbidities were assessed prior to the index surgery. Multivariate logistic and hazard regression were used to determine the relationship between risk factors and occurrence of complications after TJA. Odds ratios (OR), hazard ratios (HR), 95% confidence intervals (CI), and comparison between areas under the curve (AUC) using DeLong’s method are presented.ResultsComplications were more frequent in subjects with RA, use of corticosteroids, and previous comorbidities: respiratory disease, infections, diabetes, anemia, mental and musculoskeletal comorbidities than in subjects without these risk factors, and these factors were predictors of infections and mechanical complications (P < 0.05). A model including these factors was superior to a model with only type of joint disease (OA/RA) or age and gender to detect infections or mechanical complications after TJA (P < 0.05 for difference between models). Complication risk proportionally increased with the presence of two or more comorbidities (P < 0.001).ConclusionsThere are two groups at higher risk for infections after TJA: patients with OA with at least two risk factors and patients with RA, who usually present at least one of the risk factors for infection.

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

“…This is supported by numerous studies demonstrating that patients who develop PJI tend to have more comorbidities and are at increased risk of mortality relative to their noninfected counterparts. 77 Furthermore, rTHA procedures that were likely to produce higher levels of blood loss, such as rTHA for periprosthetic fracture or tumor excision, were also excluded from the analysis to minimize confounding variables related to the indication for rTHA. Future studies should aim to determine if risk factors for transfusion in these excluded patient cohorts are consistent with those found in this analysis.…”

Gender differences in the effect of diabetes mellitus and its treatment on osteoarthritic pain

“…Electronic records of patients included: demographic information and anamnesis, X-rays of the affected joints (hip and/or knee), laboratory exams, diagnoses, including previous surgeries and dates, between others. Other methodological considerations have been previously described 9. Patients were questioned which joints had pain in the last month for most of the days and pain was rated from 0 to 10 (numerical rating scale, NRS) for each joint.…”

Osteoarthritis and type 2 diabetes: From pathogenetic factors to therapeutic intervention

“…Surgery usually consists in total joint replacement and is performed when all the above‐mentioned approaches have failed in controlling joint pain. Subjects with T2D have twice the risk of undergoing knee or hip arthroplasty and to develop both prosthetic joint infection and mechanical complications compared with non‐diabetic patients, thus complicating the post‐operative management and the duration of joint prostheses in diabetic patients.…”