Abstract
BackgroundPatients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of prosthetic joint infection (PJI) after hip or knee replacement. However, little information is available on the demographic data, outcome of treatment and prognostic factors in RA patients when compared to those in non-RA patients.Methods/Principal FindingsWe performed a retrospective cohort analysis of all cases of PJI that were treated at our institution between 2002 and 2008. Of 346 episodes of PJI during the study period, 46 (13.3%) occurred in patients with RA. Compared to the non-RA cohort, RA patients with PJI were female predominant (74% vs 27%, p<0.001), younger (median age, 51 vs 63 years, p<0.001) and developed infection earlier (median joint age, 72 vs 128 days, p<0.001). The 2-year survival rate free of treatment failure was lower in RA patients with PJI episodes either treated with débridement (22% vs 52%, p = 0.002) or two-stage exchange (78% vs 95%, p = 0.004). A longer duration of symptoms before débridement surgery (median, 11 vs 5 days, p = 0.015), and absence of antibiotics in bone cement for two-stage exchange (relative risk, 8.0; p = 0.02) were associated with treatment failure in patients with RA.DiscussionThe outcome of PJI in RA patients was generally worse than that in non-RA patients. Risk of treatment failure increased in the setting of delayed débridement and two-stage exchange without the use of antibiotic-impregnated bone cement. These findings highlight the importance of vigilant monitoring and aggressive treatment for PJI in RA patients.
Highlights
Increased evidence reveals that patients with rheumatoid arthritis (RA) are at a high risk for developing several comorbid disorders, that these conditions may have atypical features and may be difficult to diagnose and treat [1]
Risk of treatment failure increased in the setting of delayed debridement and two-stage exchange without the use of antibiotic-impregnated bone cement
Despite improvements in operative techniques, aseptic procedures, and the use of perioperative antibiotic prophylaxis have reduced the risk of infection to around 1% in general patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) [17], this devastating complication remains a serious threat to RA patients, observed at an incidence of 3.1–4.2% [3,4]
Summary
Increased evidence reveals that patients with rheumatoid arthritis (RA) are at a high risk for developing several comorbid disorders, that these conditions may have atypical features and may be difficult to diagnose and treat [1]. Studies have shown that RA is an independent risk factor for postoperative prosthetic joint infection (PJI) [3,4,5]. Patients with underlying RA are at 1.8- to 4-fold higher risk of PJI when compared to those who undergo total hip arthroplasty (THA) or total knee arthroplasty (TKA) for other etiologies [3.4]. Patients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of prosthetic joint infection (PJI) after hip or knee replacement. Little information is available on the demographic data, outcome of treatment and prognostic factors in RA patients when compared to those in non-RA patients
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call