Abstract
BackgroundInflammatory 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.MethodsA 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.ResultsThere 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.ConclusionTwo-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.
Highlights
Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA)
Patients in the inflammatory disease group had a higher prevalence of renal disease than the control group (20.00% VS 2.52%, p = 0.003), while there was no significant difference in the other relevant risk factors according to our analysis
In the non-inflammatory disease group, we mainly found Coagulase negative staphylococci (CNS) (n = 42, 26.42%), S. aureus (n = 33, 20.75%), gramnegative bacillus (n = 12, 7.55%) and other pathogens. 35 out of 129 microorganisms were resistant to methicillin and vancomycin
Summary
Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). 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. Several studies have suggested a decreasing trend in the occurrence of inflammatory diseases [2, 3], there are a considerable number of individuals with inflammatory diseases with severe arthritis who are candidates for total joint arthroplasty (TJA) [4]. Individuals with a medical history of an inflammatory disease have been shown to be independently associated with more than 4 times as many subsequent PJIs than those with osteoarthritis due to the long-term use of disease-modifying antirheumatic drugs (DMARDs) [11], biological drugs and corticosteroids [12,13,14,15,16,17]
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