RESEARCH - Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with RA

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Arthritis Rheum. 2008 Nov 26;59(12):1713-1720.

Incidence and risk factors of prosthetic joint infection after total

hip or knee replacement in patients with rheumatoid arthritis.

Bongartz T, Halligan CS, Osmon DR, Reinalda MS, Bamlet WR, Crowson CS,

Hanssen AD, Matteson EL.

Mayo Clinic College of Medicine, Rochester, Minnesota.

OBJECTIVE: Prosthetic joint infection is one of the most dreaded

complications after total joint arthroplasty, a common procedure in

patients with rheumatoid arthritis (RA). We conducted a study to

evaluate potential risk factors of prosthetic joint infection and to

clarify if RA is an independent predictor of this complication.

METHODS: This study included all patients with RA who underwent total

hip or knee replacement at the Mayo Clinic Rochester between January

1996 and June 2004. The association of potential risk factors with

prosthetic joint infection was examined using models. A matched

cohort of patients with osteoarthritis (OA) was assembled to determine

whether RA is an independent risk factor for prosthetic joint

infection.

RESULTS: We identified 462 patients with RA who underwent a total of

657 hip or knee replacements. Overall, 23 (3.7%) joint arthroplasties

were complicated by an infection during a mean +/- SD followup of 4.3

+/- 2.4 years. Revision arthroplasty (hazard ratio

---

2.99, 95%

confidence interval [95% CI] 1.02-8.75) and a previous prosthetic

joint infection of the replaced joint (HR 5.49, 95% CI 1.87-16.14)

were significant predictors of postoperative prosthetic joint

infection. Comparison of RA patients with a matched cohort of OA

patients identified an increased risk of prosthetic joint infections

(HR 4.08, 95% CI 1.35-12.33) in patients with RA.

CONCLUSION: Patients with RA who undergo total hip or knee replacement

are at increased risk of prosthetic joint infection, which is further

increased in the setting of revision arthroplasty and a previous

prosthetic joint infection. These findings highlight the importance of

perioperative prophylactic measures and vigilance during the

postoperative period.

PMID: 19035425

http://www.ncbi.nlm.nih.gov/pubmed/19035425

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