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Archives of Orthopaedic and Trauma Surgery

19-03-2024 | Rheumatoid Arthritis | Orthopaedic Surgery

Periprosthetic joint infections in patients with rheumatoid arthritis are associated with higher complication and mortality rates

Authors: Lucio Cappelli Toledo de Araujo, Anette Westerholt, Amir N. Sandiford, Angelika Gursche, Daniel Kendoff

Published in: Archives of Orthopaedic and Trauma Surgery

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Abstract

Introduction

Periprosthetic joint infection (PJI) remains the most devasting complication after total joint arthroplasty (TJA). There has been a significant focus on this topic in recently-published medical literature. However, relatively little has been published about PJI in patients with rheumatoid arthritis (RA), which are often physiologically frail and immunocompromised. A better understanding of PJI in this patient population is therefore crucial. The main aims of this paper are to (1) report complication and mortality rates in a cohort of PJI-RA patients; and (2) clinically characterize them.

Methods

Medical and surgical records of all RA PJI patients treated surgically from 2003 to 2020 were retrospectively reviewed. Medical history, physical examination, reactive protein (CRP) level, procalcitonin, white blood cell (WBC) count, joint aspiration results, and cultures were used to determine PJI.

Results

54PJIs, 49 of them chronic, were treated in 53RA patients. Mean patient age was 65 yrs. (range = 32–88); 33females and 20 males (one bilateral hip). The overall mortality rate was 18.9%(n = 10), with five deaths directly attributed to PJI. Staphylococci accounted for 34 infections (63%), while 11(20.4%) had multiorganism infections and six culture-negative PJI. At the end of treatment 79.6%(n = 43) still had an implanted TJR, 7.4% (n = 4) had spacers, 5.6%(n = 3) had undergone resection arthroplasty, 3.7%(n = 2) arthrodesis, and one each amputation and exarticulation.

Conclusions

Mortality and specially complication rates were (are) high in this RA patients group presenting PJI. Delays to diagnosis and treatment may explain some of these poor outcomes.

Level of evidence

A cohort level III retrospective study.
Literature
1.
Berbari EF et al (2006) Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis 42(2):216–223CrossRefPubMed
2.
Jr Harris ED (1990) Rheumatoid arthritis. Pathophysiology and implications for therapy. N Engl J Med 322(18):1277–89CrossRef
3.
Alarcon GS et al (1995) Survival and drug discontinuation analyses in a large cohort of methotrexate treated rheumatoid arthritis patients. Ann Rheum Dis 54(9):708–712CrossRefPubMedPubMedCentral
4.
Amaya-Amaya J, Mantilla RD et al (2013) Autoimmunity: from bench to bedside. El Rosario University Press, Gogota, Colombia
5.
Hsieh PH, Huang KC, Shih HN (2013) Prosthetic joint infection in patients with rheumatoid arthritis: an outcome analysis compared with controls. PLoS One 8(8):e71666ADSCrossRefPubMedPubMedCentral
6.
7.
8.
Thomas E et al (2003) National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study. J Rheumatol 30(5):958–965PubMed
9.
Bongartz T et al (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 59(12):1713–1720CrossRefPubMedPubMedCentral
10.
Berbari EF et al (1998) Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 27(5):1247–1254CrossRefPubMed
11.
Lenguerrand E et al (2018) Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. Lancet Infect Dis 18(9):1004–1014CrossRefPubMedPubMedCentral
12.
Lenguerrand E et al (2019) Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis 19(6):589–600CrossRefPubMedPubMedCentral
13.
Shahi A et al (2017) In-hospital mortality in patients with periprosthetic joint infection. J Arthroplasty 32(3):948-952 e1CrossRefPubMed
14.
Parvizi J, Fassihi SC, Enayatollahi MA (2016) Diagnosis of periprosthetic joint infection following hip and knee arthroplasty. Orthop Clin North Am 47(3):505–515CrossRefPubMed
15.
Cordtz R et al (2020) Risk of medical complications following total hip or knee arthroplasty in patients with rheumatoid arthritis: a register-based cohort study from Denmark. Semin Arthritis Rheum 50(1):30–35CrossRefPubMed
16.
Cordtz RL et al (2018) Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers. Ann Rheum Dis 77(2):281–288CrossRefPubMed
17.
Thakrar RR et al (2019) Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J 101-B(1_Supple_A):19–24MathSciNetCrossRefPubMed
18.
Singh JA et al (2015) Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet 386(9990):258–265CrossRefPubMedPubMedCentral
19.
Goodman SM et al (2016) Management of perioperative tumour necrosis factor alpha inhibitors in rheumatoid arthritis patients undergoing arthroplasty: a systematic review and meta-analysis. Rheumatology (Oxford) 55(3):573–582PubMed
20.
Eka A, Chen AF (2015) Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann Transl Med 3(16):233PubMedPubMedCentral
21.
Premkumar A et al (2018) Periprosthetic joint infection in patients with inflammatory joint disease: prevention and diagnosis. Curr Rheumatol Rep 20(11):68CrossRefPubMedPubMedCentral
22.
Schwarz EM et al (2019) 2018 international consensus meeting on musculoskeletal infection: research priorities from the general assembly questions. J Orthop Res 37(5):997–1006CrossRefPubMed
23.
Bozic KJ et al (2012) Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am 94(9):794–800ADSCrossRefPubMed
24.
Parvizi J et al (2001) Thirty-day mortality after elective total hip arthroplasty. J Bone Joint Surg Am 83(10):1524–1528CrossRefPubMed
25.
Parvizi J et al (2001) Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am 83(8):1157–1161CrossRefPubMed
26.
27.
Singh N et al (2019) Risk of recurrent staphylococcus aureus prosthetic joint infection in rheumatoid arthritis patients-a nationwide cohort study. Open Forum Infect Dis 6(11):ofz451CrossRefPubMedPubMedCentral
28.
Buchholz HW et al (1981) Management of deep infection of total hip replacement. J Bone Joint Surg Br 63-B(3):342–53CrossRefPubMed
29.
Sihvonen S et al (2006) Mortality in patients with rheumatoid arthritis treated with low-dose oral glucocorticoids A population-based cohort study. J Rheumatol 33(9):1740–1746PubMed
30.
Borgas Y et al (2020) Anti-rheumatic treatment and prosthetic joint infection: an observational study in 494 elective hip and knee arthroplasties. BMC Musculoskelet Disord 21(1):410CrossRefPubMedPubMedCentral
31.
32.
Tahta M et al (2019) Does inflammatory joint diseases affect the accuracy of infection biomarkers in patients with periprosthetic joint infections? A prospective comparative reliability study. J Orthop Sci 24(2):286–289CrossRefPubMed
Metadata
Title
Periprosthetic joint infections in patients with rheumatoid arthritis are associated with higher complication and mortality rates
Authors
Lucio Cappelli Toledo de Araujo
Anette Westerholt
Amir N. Sandiford
Angelika Gursche
Daniel Kendoff
Publication date
19-03-2024
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-024-05248-y