scholarly journals THU0072 Risk of revision, prosthetic joint infection and death following total hip or knee arthroplasty in patients with rheumatoid arthritis – a nationwide cohort study from denmark

Author(s):  
RL Cordtz ◽  
LE Kristensen ◽  
S Overgaard ◽  
A Odgaard ◽  
H Lindegaard ◽  
...  
2017 ◽  
Vol 77 (2) ◽  
pp. 281-288 ◽  
Author(s):  
Rene Lindholm Cordtz ◽  
Kristian Zobbe ◽  
Pil Højgaard ◽  
Lars Erik Kristensen ◽  
Søren Overgaard ◽  
...  

ObjectivesTo investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.MethodsRegister-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.ResultsIn total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality.ConclusionPatients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.


2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Namrata Singh ◽  
Rajeshwari Nair ◽  
Michihiko Goto ◽  
Martha L Carvour ◽  
Ryan Carnahan ◽  
...  

AbstractBackgroundTreatment of rheumatoid arthritis (RA) often involves immune-suppressive therapies. Concern for recurrent prosthetic joint infection (PJI) in RA patients might be high and could reduce use of joint implantation in these patients. We aimed to evaluate the risk of recurrence of PJI in RA patients compared with osteoarthritis (OA) patients by utilizing a large health care system.MethodsWe conducted a retrospective cohort study of all patients admitted for a Staphylococcus aureus PJI who underwent debridement, antibiotics, and implant retention (DAIR) or 2-stage exchange (2SE) between 2003 and 2010 at 86 Veterans Affairs Medical Centers. Both RA patients and the comparison group of osteoarthritis (OA) patients were identified using International Classification of Diseases, Ninth Revision, codes. All index PJI and recurrent positive cultures for S. aureus during 2 years of follow-up were validated by manual chart review. A Cox proportional hazards regression model was used to compare the time to recurrent PJI for RA vs OA.ResultsIn our final cohort of 374 veterans who had either DAIR or 2SE surgery for their index S. aureus PJI, 11.2% had RA (n = 42). The majority of the cohort was male (97.3%), and 223 (59.6%) had a methicillin-susceptible S. aureus PJI. RA patients had a similar risk of failure compared with OA patients, after adjusting for covariates (hazard ratio, 0.81; 95% confidence interval, 0.48–1.37).ConclusionsPrior diagnosis of RA does not increase the risk of recurrent S. aureus PJI. Further studies are needed to evaluate the effect of different RA therapies on outcomes of episodes of PJI.


2015 ◽  
Vol 36 (10) ◽  
pp. 1198-1207 ◽  
Author(s):  
Leslie Grammatico-Guillon ◽  
Sabine Baron ◽  
Philippe Rosset ◽  
Christophe Gaborit ◽  
Louis Bernard ◽  
...  

BACKGROUNDHip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.OBJECTIVETo assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.METHODSA historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.RESULTSA total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.CONCLUSIONSThe hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.Infect Control Hosp Epidemiol 2015;36(10):1198–1207


2008 ◽  
Vol 59 (12) ◽  
pp. 1713-1720 ◽  
Author(s):  
Tim Bongartz ◽  
Christine S. Halligan ◽  
Douglas R. Osmon ◽  
Megan S. Reinalda ◽  
William R. Bamlet ◽  
...  

2021 ◽  
Author(s):  
Yu-Hsiang Lee ◽  
Chen-Chih Chiu ◽  
Chin-Yuan Chang

Today, prosthetic joint infection (PJI) is still a relatively rare but devastating complication following total hip and/or knee arthroplasty. The treatment of PJI is difficult due to a number of...


2009 ◽  
Vol 24 (2) ◽  
pp. e4 ◽  
Author(s):  
Steven M. Kurtz ◽  
Kevin Ong ◽  
Edmund Lau ◽  
Kevin J. Bozic ◽  
Javad Parvizi ◽  
...  

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