Risk of postoperative infections and the discontinuation of TNF inhibitors in patients with rheumatoid arthritis: A meta-analysis

Clay, Marine; Mazouyes, Arnaud; Gilson, Mélanie; Gaudin, Philippe; Baillet, Athan

doi:10.1016/j.jbspin.2015.10.019

Cited by 32 publications

(14 citation statements)

References 25 publications

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“…A meta analysis comparing continuation versus discontinuation of TNF-alpha inhibitors prior to orthopedic surgery favors discontinuation of bDMARDs [8], although the studies included are heterogeneous in terms of differing timing of treatment interruption and the variety of patients and operations included. Furthermore, the included studies were underpowered to detect small changes in infection rate.…”

Section: Discussionmentioning

confidence: 99%

Anti-rheumatic treatment and prosthetic joint infection: an observational study in 494 elective hip and knee arthroplasties

Borgas

Gülfe

Kindt

et al. 2020

BMC Musculoskelet Disord

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Background: Surgical site infections are more frequent among patients with rheumatic disease. To what extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively. The aim of study was to assess the rate of surgical site infections after knee and hip replacement in patients with inflammatory joint disease, with an emphasis on periprosthetic joint infection, and to investigate the influence of treatment with disease-modifying antirheumatic drugs (DMARDs) in this regard. Methods: Data were collected from 494 primary elective hip (51.4%) and knee arthroplasties, along with demographic and medication data. The primary outcome was surgical site infection during the first year after surgery. Results: In 78% (n = 385) of the cases the patient used 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty-two percent (n = 157) of patients used a TNF-alpha inhibitor. The rate of surgical site infection was 3.8% (n = 19). The rate of periprosthetic joint infection was 1.4% (n = 7), all of which occurred after knee arthroplasty. Periprosthetic joint infection occurred in only 1 patient medicating perioperatively with a TNF-alpha inhibitor. Conclusion: Surgical site infections were not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to the low event rate this should be interpreted with caution, but our center will maintain its routine of continuing treatment with TNF-alpha inhibitors perioperatively.

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Section: Discussionmentioning

confidence: 99%

Anti-rheumatic treatment and prosthetic joint infection: an observational study in 494 elective hip and knee arthroplasties

Borgas

Gülfe

Kindt

et al. 2020

BMC Musculoskelet Disord

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“…Therefore, we consider that good indications for using this method can be osteochondral fractures and open fractures with bone defects around the thumb IP joint, and nonunion of the thumb proximal phalanx. Especially, in the patients with multiple risk factors of postoperative fracture‐related infection, including open fracture, poor local soft tissue condition, diabetes mellitus, steroid or immunosuppressant use and so on (Clay, Mazouyes, Gilson, Gaudin, & Baillet, 2016; Niikura et al, 2014), this method could be a powerful option.…”

Section: Discussionmentioning

confidence: 99%

Reverse radiodorsal artery‐pedicled thumb metacarpal vascularized bone graft for osteochondral fracture of the thumb interphalangeal joint with a bone defect: A case report

et al. 2020

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Osteochondral fractures of the fingers are challenging to treat, and it is mandatory to acquire early bone union and joint surface reconstruction to obtain satisfactory outcomes. These injuries sometimes occur as open fractures with poor soft tissue condition and bone defect adjacent to osteochondral fragment. For such cases, surgical treatment can be more difficult, and vascularized bone graft (VBG) could be a useful method for joint reconstruction. Here, we report reverse‐pedicled VBG based on the radiodorsal artery of the thumb for reconstructing a traumatic bone defect of the thumb. A 36‐year‐old man, who had ulcerative colitis and was taking immunosuppressive agents, sustained open fracture‐dislocation of the thumb interphalangeal joint with a free osteochondral fragment of the proximal phalanx and 6 × 5 × 4 mm of subcondylar bone defect. We harvested 5 × 5 × 5 mm VBG at the base of the first metacarpal bone and dissected running the radiodorsal artery. The vascularized bone was grafted into the bone defect site through the subcutaneous tunnel created on the radial aspect of the proximal phalanx and fixed with a Kirschner wire. Bony union was obtained 2 months after surgery. At 7 months after the operation, the patient complained no pain, and the range of motion of the thumb interphalangeal joint was extension 0° and flexion 42°. Radiographs showed no avascular necrosis of the united fragment and osteoarthritis of the interphalangeal joint. This method could be a useful option for reconstruction of the thumb with bone defects.

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“…A meta analysis comparing continuation versus discontinuation of TNF-alpha inhibitors prior to orthopedic surgery favors discontinuation of bDMARD (8) although the studies included are heterogeneous with different time of treatment interruption and a variety of patients and operations included. Further, the included studies were underpowered to detect small changes in infection rate.…”

Section: Discussionmentioning

confidence: 99%

Anti-rheumatic treatment and prosthetic joint infection: An observational study in 494 elective hip and knee arthroplasties.

Borgas

Gülfe

Kindt

et al. 2019

Preprint

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Abstract Background Surgical site infections are more frequent among patients with rheumatic disease. To which extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively.Objectives To assess the rate of surgical site infections after knee and hip-replacement in patients with inflammatory joint disease, with emphasis on periprosthetic joint infection, and to investigate the importance of medical treatment in this regard.Methods Data was collected from 494 primary elective hip- (51.4%) and knee arthroplasties along with demographic and medication data and primary outcome was surgical site infections during the first year after surgery.Results In 78% (n=385) of the cases the patient medicated with 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty two per cent (n=157) of patients were on a TNF-alpha inhibitor perioperatively. The rate of surgical site infections was 3.8% (n=19) The rate of periprosthetic joint infection was 1.4% (n=7), all of which were knee arthroplasties. Only in 1 case of periprosthetic joint infection the patient medicated perioperatively with a TNF-alpha inhibitor.Conclusion Surgical site infections was not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to low event rate this should be interpreted with caution. Routines at our centre, not stopping biologic disease-modifying antirheumatic drugs perioperatively, will be unchanged.

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Risk of postoperative infections and the discontinuation of TNF inhibitors in patients with rheumatoid arthritis: A meta-analysis

Cited by 32 publications

References 25 publications

Anti-rheumatic treatment and prosthetic joint infection: an observational study in 494 elective hip and knee arthroplasties

Anti-rheumatic treatment and prosthetic joint infection: an observational study in 494 elective hip and knee arthroplasties

Reverse radiodorsal artery‐pedicled thumb metacarpal vascularized bone graft for osteochondral fracture of the thumb interphalangeal joint with a bone defect: A case report

Anti-rheumatic treatment and prosthetic joint infection: An observational study in 494 elective hip and knee arthroplasties.

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