Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis

Abstract

Objective Prosthetic joint infection is one of the most dreaded complications after total joint arthroplasty, a common procedure in patients with rheumatoid arthritis (RA). We conducted a study to evaluate potential risk factors of prosthetic joint infection and to clarify if RA is an independent predictor of this complication. Methods This study included all patients with RA who underwent total hip or knee replacement at the Mayo Clinic Rochester between January 1996 and June 2004. The association of potential risk factors with prosthetic joint infection was examined using Cox models. A matched cohort of patients with osteoarthritis (OA) was assembled to determine whether RA is an independent risk factor for prosthetic joint infection. Results We identified 462 patients with RA who underwent a total of 657 hip or knee replacements. Overall, 23 (3.7%) joint arthroplasties were complicated by an infection during a mean ± SD followup of 4.3 ± 2.4 years. Revision arthroplasty (hazard ratio [HR] 2.99, 95% confidence interval [95% CI] 1.02–8.75) and a previous prosthetic joint infection of the replaced joint (HR 5.49, 95% CI 1.87–16.14) were significant predictors of postoperative prosthetic joint infection. Comparison of RA patients with a matched cohort of OA patients identified an increased risk of prosthetic joint infections (HR 4.08, 95% CI 1.35–12.33) in patients with RA. Conclusion Patients with RA who undergo total hip or knee replacement are at increased risk of prosthetic joint infection, which is further increased in the setting of revision arthroplasty and a previous prosthetic joint infection. These findings highlight the importance of perioperative prophylactic measures and vigilance during the postoperative period.

Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: A prospective, population‐based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register

“…For THRs, the literature is conflicting (1,14,18). We did not confirm the findings of some study groups who reported an increased risk of deep infection in RA patients both in TKR and THR (13,16). Nor did we agree with Berbari et al (12), who reported no increased risk in TKR as well as THR (Table 3).…”

“…There are conflicting reports on whether this increased baseline risk of infections in RA patients might influence the risk of deep infection after primary total joint replacement surgery (1,5,(11)(12)(13)(14)(15)(16)(17)(18).…”

Revision Total Knee Arthroplasty for Aseptic and Septic Causes in Patients with Rheumatoid Arthritis

“…The failure rate in our selected series is similar to previously published reports (Table 8) [26,29]. With regard to patients treated for infection, our failure rate of 25% is also comparable to the results of others (Table 8) [1,3]. Bongartz et al questioned whether this high rate of reinfection was actually due to persistent undetectable bacteria [3], whereas, Berbari et al demonstrated that a two-staged infection protocol may yield the best survival for patients with rheumatoid arthritis [1].…”

“…With regard to patients treated for infection, our failure rate of 25% is also comparable to the results of others (Table 8) [1,3]. Bongartz et al questioned whether this high rate of reinfection was actually due to persistent undetectable bacteria [3], whereas, Berbari et al demonstrated that a two-staged infection protocol may yield the best survival for patients with rheumatoid arthritis [1]. The high rate of failure observed in patients with rheumatoid arthritis is likely multifactorial as this autoimmune disease can directly affect a patient's bone quality [32], ligament integrity [22], and reactivation of joint synovitis can lead to further implant loosening [6].…”

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

“…In addition to being a source of considerable morbidity, each infected arthroplasty is estimated to cost Ͼ$30,000, on average, to manage (16). Foremost among the potential explanations for this increased risk is that RA is a systemic autoimmune disorder, and it is managed with immunomodulatory drugs that have been linked to increased risk of infection (disease-modifying antirheumatic drugs, systemic corticosteroids, antimalarials, and biologic therapies) (54)(55)(56)(57). However, to our knowledge, the impact of biologic agents on the risk of infection following TJA has not been examined.…”