Patients with rheumatoid arthritis (RA) have a heightened risk for joint infection after knee or hip replacement compared with their non-RA counterparts, US researchers have shown.
Prosthetic joint infection is a significant complication of total joint arthroplasty and is associated with significant morbidity and healthcare expenditure.
In the present study, Tim Bongartz (Mayo Clinic, Rochester, Minnesota) and colleagues retrospectively examined the incidence and outcomes of prosthetic joint infection among 452 patients with RA who underwent total hip or total knee replacement at the Mayo Clinic between 1996 and 2004.
A total of 23 (3.7%) arthroplasties were complicated by infection during a mean follow-up of 4.3 years, Bongartz’s team reports in the journal Arthritis & Rheumatism. Hip and knee arthroplasties were equally prone to infection.
Two factors were significant and independent predictors for joint infection: revision arthroplasty (hazard ratio
=2.99) and a previous prosthetic joint infection (HR=5.49).
For comparison, the authors identified a matched cohort of osteoarthritis patients who underwent joint replacement at the Mayo Clinic during the same time period. In this group the incidence of joint infection was 1.4%.
“The higher risk in patients with RA was statistically significant (HR=4.08), even after adjusting for previous infection in the index joint,” the authors comment.
They say their findings emphasize the importance of using all possible pre- and postoperative prophylactic measures, particularly in the setting of a revision arthroplasty or a preceding infection. Such measures include debridement and long-term antibiotic suppression therapy.