Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: a prospective, population-based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register.
OBJECTIVE
To compare differences in the risk of revision for infection and changes in risk over time and in time from primary surgery to revision for infection after total hip replacement (THR) and total knee replacement (TKR) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients.


METHODS
In the Norwegian Arthroplasty Register, 6,629 and 102,157 primary total joint replacements in patients with RA and OA, respectively, were identified from 1987 (1994 for knees) until 2008. Survival analyses with revision due to infection as the end point were performed using Kaplan-Meier methods for constructing survival curves and multiple Cox regression to calculate relative risk (RR) estimates for diagnosis, age, sex, and year of primary surgery. An extended Cox model was used to estimate RR within different followup intervals.


RESULTS
RA patients with TKR had a 1.6 times higher risk of revision for infection than OA patients, whereas there was no difference in the THRs. In the THRs, we found a higher risk of revision for infection from 2001 onward, whereas the development for TKRs was the opposite. These time effects affected the RA and OA groups equally. The risk of revision for infection from 6 years postoperatively on was higher in RA patients.


CONCLUSIONS
The overall risk of revision for infection after TKR was higher in RA patients. The risk of late infection leading to revision of the TKR and THR was higher in RA patients than in OA patients. After the year 2000, the RR of revision for infection in RA compared with OA remained unchanged.
Schrama
Johannes C
JC
Department of Orthopaedic Surgery, Haukeland University Hospital and Norwegian Arthroplasty Register, Bergen, Norway. johannes.schrama@helse-bergen.no
Espehaug
Birgitte
B
Hallan
Geir
G
Engesaeter
Lars B
LB
Furnes
Ove
O
Havelin
Leif I
LI
Fevang
Bjorg-Tilde S
BT
D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology*