Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes.
BACKGROUND
Prosthetic joint infection in patients with rheumatoid arthritis is a serious complication of total joint arthroplasty. Little information is available on the outcome of medical and surgical treatments of prosthetic joint infection in patients with rheumatoid arthritis.


METHODS
We conducted a retrospective analysis of all patients with rheumatoid arthritis and a total hip or total knee arthroplasty infection evaluated at Mayo Clinic (Rochester, MN) between 1 January 1969 and 31 December 1995.


RESULTS
A total of 200 first episodes of prosthetic joint infection in 160 patients with rheumatoid arthritis were diagnosed during the study period. Thirty-seven percent of prosthetic joint infection episodes were due to Staphylococcus aureus. Of these episodes, 23% and 19% were treated with debridement and retention of components and 2-stage exchange, respectively. The type of surgical procedure was the only analyzed clinical variable that was associated with treatment failure (P < .001). Rates of 5-year survival free of treatment failure for patients with prosthetic joint infection episodes treated with debridement and retention of components, 2-stage exchange, and resection arthroplasty were 32% (95% confidence interval [CI], 21%-49%), 79% (95% CI, 66%-93%), and 61% (95% CI, 49%-74%), respectively.


CONCLUSIONS
S. aureus is the most common pathogen among patients with rheumatoid arthritis with prosthetic joint infection. Two-stage exchange was used in only 19% of the prosthetic joint infection episodes among patients with rheumatoid arthritis during the study period, but it was associated with the best outcome. The variable most strongly associated with the outcome was the type of surgical procedure.
Berbari
Elie F
EF
Mayo Clinic College of Medicine, Rochester, MN, USA. berbari.elie@mayo.edu
Osmon
Douglas R
DR
Duffy
Mary C T
MC
Harmssen
R N William
RN
Mandrekar
Jayawant N
JN
Hanssen
Arlen D
AD
Steckelberg
James M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001424:Bacterial Infections / Q000209:etiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
D000900:Anti-Bacterial Agents