Artikel
Rheumatoid arthritis carries an increased risk for septic revision surgery in total hip (THA) and total knee arthroplasty (TKA) and for aseptic revision surgery in THA – an analysis of 23,755 procedures from the German arthroplasty registry
Suche in Medline nach
Autoren
-
Lorenz Pichler
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
-
Joost Burger
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
-
Alexander Grimberg
- EPRD, Deutsche Endoprothesenregister gGmbH, Berlin, Germany
-
Yinan Wu
- EPRD, Deutsche Endoprothesenregister gGmbH, Berlin, Germany
-
Bernd Kladny
- m&i-Fachklinik Herzogenaurach, Orthopädie/Unfallchirurgie, Herzogenaurach, Germany
-
Carsten Perka
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
-
Sebastian Braun
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| Veröffentlicht: | 21. Oktober 2024 |
|---|
Gliederung
Text
Objectives: Rheumatoid arthritis (RA) is associated with periarticular bone loss and an increased risk of postoperative infection in total joint arthroplasty (TJA) [1]. The aim of this study was to explore the effects of RA on the risk of aseptic and septic revision surgeries following both primary THA and primary TKA.
Methods: Data from the German Arthroplasty Registry (EPRD) were analyzed for the period between January 2016 and March 2023. The analysis included 11,003 THA and 12,752 TKA procedures performed on patients diagnosed with RA at the time of implantation. These cases were compared with 468,307 THA and 385,129 TKA procedures in patients without RA. Cumulative revision rates for both aseptic and septic surgeries over a 7-year period were reported, and log-rank tests were utilized for statistical comparison.
Results and conclusion: Over a seven-year period, the cumulative risk for aseptic revision surgery among RA patients was found to be 4% (CI, 3.6–4.6%) for THA and 2.9% (CI, 2.6–3.3%) for TKA. In comparison, non-RA patients experienced a cumulative risk of 2.7% (CI, 2.6–2.7%; p=0.0001*) for THA and 2.8% (CI, 2.7–2.9%; p=0.7) for TKA. The cumulative risk for septic revision surgery in RA patients was 1.8% (CI, 1.5–2.1%) for THA and 1.9% (CI, 1.6–2.3%) for TKA, compared to 1.4% (CI, 1.3–1.4%; p<0.0001*) for THA and 1.4% (CI, 1.3–1.4%; p=0.001) for TKA in non-RA patients.
Rheumatoid arthritis carries a modest yet significantly increased 7-year cumulative risk for septic revision surgery in both THA and in TKA, thereby confirming the increased rate of postoperative infections reported among RA patients undergoing TJA [1]. Additionally, an elevated cumulative risk for aseptic revision surgery was observed in RA patients undergoing THA, but not in those undergoing TKA. This discrepancy may reflect the greater incidence of hip dislocation attributed to compromised soft tissue quality in RA patients [2] as well as the beneficial effects of modern anti-rheumatic treatments on bone density [3].
Figure 1 [Fig. 1]
References
- 1.
- Bongartz T, Halligan CS, Osmon DR, Reinalda MS, Bamlet WR, Crowson CS, Hanssen AD, Matteson EL. Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum. 2008 Dec 15;59(12):1713-20. DOI: 10.1002/art.24060
- 2.
- Ravi B, Escott B, Shah PS, Jenkinson R, Chahal J, Bogoch E, Kreder H, Hawker G. A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum. 2012 Dec;64(12):3839-49. DOI: 10.1002/art.37690
- 3.
- Szentpetery A, Heffernan E, Haroon M, Kilbane M, Gallagher P, McKenna MJ, FitzGerald O. Striking difference of periarticular bone density change in early psoriatic arthritis and rheumatoid arthritis following anti-rheumatic treatment as measured by digital X-ray radiogrammetry. Rheumatology (Oxford). 2016 May;55(5):891-6. DOI: 10.1093/rheumatology/kev443
