Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis.
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 Cox 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 [HR] 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.


CONCLUSIONS
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.
Bongartz
Tim
T
Mayo Clinic College of Medicine, Division of Rheumatology, Rochester, Minnesota 55905, USA. bongartz.tim@mayo.edu
Halligan
Christine S
CS
Osmon
Douglas R
DR
Reinalda
Megan S
MS
Bamlet
William R
WR
Crowson
Cynthia S
CS
Hanssen
Arlen D
AD
Matteson
Eric L
EL
D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors
D018501:Antirheumatic Agents