Two-stage exchange Arthroplasty is a viable treatment for Periprosthetic joint infection in inflammatory diseases

Abstract

Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases. Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8 ± 1385.3*109/mL) and group C (1315.8 ± 1849.3*109/mL, p = 0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group. Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.

Combination of C-reactive protein and fibrinogen is useful for diagnosing periprosthetic joint infection in patients with inflammatory diseases

“…Patients with inflammatory diseases are at significantly higher risk of total joint arthroplasty (TJA) than healthy individuals due to their use of glucocorticoids and the continuous stimulation of inflammatory cytokines in the joints. [6] Patients with inflammatory diseases are also at higher risk of periprosthetic joint infection (PJI) after TJA. [7,8] These infections lead to higher hospitalization expenses, longer hospital stays, and more disabilities, even mortality, especially if they are not diagnosed before undergoing revision hip or knee arthroplasty.…”

“…Inflammatory diseases such as rheumatoid arthritis, [1] ankylosing spondylitis, [2] psoriatic arthritis, [3] systemic lupus erythematosus (SLE), [4] and gouty arthritis [5] are characterized by high levels of inflammatory cytokines in the body. Patients with inflammatory diseases are at significantly higher risk of total joint arthroplasty (TJA) than healthy individuals due to their use of glucocorticoids and the continuous stimulation of inflammatory cytokines in the joints [6] . Patients with inflammatory diseases are also at higher risk of periprosthetic joint infection (PJI) after TJA [7,8] .…”