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

Abstract

Objective. To compare differences in the risk of revision for infection and changes in risk over time and in time from primary surgery to revision for infection after total hip replacement (THR) and total knee replacement (TKR) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients. Methods. In the Norwegian Arthroplasty Register, 6,629 and 102,157 primary total joint replacements in patients with RA and OA, respectively, were identified from 1987 (1994 for knees) until 2008. Survival analyses with revision due to infection as the end point were performed using Kaplan-Meier methods for constructing survival curves and multiple Cox regression to calculate relative risk (RR) estimates for diagnosis, age, sex, and year of primary surgery. An extended Cox model was used to estimate RR within different followup intervals. Results. RA patients with TKR had a 1.6 times higher risk of revision for infection than OA patients, whereas there was no difference in the THRs. In the THRs, we found a higher risk of revision for infection from 2001 onward, whereas the development for TKRs was the opposite. These time effects affected the RA and OA groups equally. The risk of revision for infection from 6 years postoperatively on was higher in RA patients. Conclusion. The overall risk of revision for infection after TKR was higher in RA patients. The risk of late infection leading to revision of the TKR and THR was higher in RA patients than in OA patients. After the year 2000, the RR of revision for infection in RA compared with OA remained unchanged.

Risk Calculators Predict Failures of Knee and Hip Arthroplasties: Findings from a Large Health Maintenance Organization

“…Similar to other studies that have examined revision risk factors, we identified sex, age, BMI, diagnosis, and diabetes as patient risk factors of revision [17,28,40,41]. Two studies [5,37] examined predictors for inclusion in total joint arthroplasty risk calculators.…”

Stromal Vascular Fraction Cells of Adipose and Connective Tissue in People with Osteoarthritis: A Case Control Prospective Multi-Centric Non-Randomized Study

“…In case of advanced stage large-joint OA, standard treatment consists in surgical removal of the affected joint and its replacement with an artificial joint. Total joint arthroplasty represents rather extensive surgery which is associated with considerable risk of serious side effects and post-operative complications including myocardial infarction, stroke, systemic infection or increased risk of death after TJA [2][3][4][5].…”

“…Although early stages of OA can be alleviated by physical therapy, weight loss, non-steroid analgesic drugs, and chondroprotectives, risk of death at 30 and 90 days after surgery, and the life-span of the prosthesis is limited [2][3][4][5].…”

Risk Factors for Early Revision After Primary Total Hip Arthroplasty in Medicare Patients

“…They found that MI THA was associated with a significantly increased risk of early revision compared with conventional THA (1.4 years versus 14.7 years, odds ratio = 26.5). Finally, Schrama et al [20] evaluated differences in the risk of revision THA for infection among patients with rheumatoid arthritis and osteoarthritis. Using data from the Norwegian Arthroplasty Register, they reported a higher risk of late ([ 6 years postoperatively) infection leading to revision THA in patients with rheumatoid arthritis compared to patients with osteoarthritis [20].…”