Moderating effects of immunosuppressive medications and risk factors for post-operative joint infection following total joint arthroplasty in patients with rheumatoid arthritis or osteoarthritis.
Inconclusive findings about infection risks, importantly the use of immunosuppressive medications in patients who have undergone large-joint total joint arthroplasty, challenge efforts to provide evidence-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a post-operative infection in patients undergoing TJA of a large joint (total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty) by identifying clinical and demographic factors, including the use of high-risk medications (i.e., prednisone and immunosuppressive medications) and diagnoses [i.e., rheumatoid arthritis (RA), osteoarthritis (OA), gout, obesity, and diabetes mellitus] that are linked to infection status, controlling for length of follow-up.



A retrospective, case-control study (N = 2212) using de-identified patient health claims information from a commercially insured, U.S. dataset representing 15 million patients annually (from January 1, 2007 to December 31, 2009) was conducted. Descriptive statistics, t-test, chi-square test, Fisher's exact test, and multivariate logistic regression were used.



Male gender (OR = 1.42, p < 0.001), diagnosis of RA (OR = 1.47, p = 0.031), diabetes mellitus (OR = 1.38, p = 0.001), obesity (OR = 1.66, p < 0.001) or gout (OR = 1.95, p = 0.001), and a prescription for prednisone (OR = 1.59, p < 0.001) predicted a post-operative infection following total joint arthroplasty. Persons with post-operative joint infections were significantly more likely to be prescribed allopurinol (p = 0.002) and colchicine (p = 0.006); no significant difference was found for the use of specific disease-modifying anti-rheumatic drugs and TNF-α inhibitors.



High-risk, post-operative joint infection groups were identified allowing for precautionary clinical measures to be taken.
College of Nursing, University of Kentucky, Lexington, KY. Electronic address: egsalt0@uky.edu.
Elizabeth
E
Salt
College of Nursing, University of Kentucky, Lexington, KY.
Amanda T
AT
Wiggins
College of Nursing, University of Kentucky, Lexington, KY.
Mary Kay
MK
Rayens
Lexington Clinic, Lexington, KY.
Brent J
BJ
Morris
College of Public Health, Department of Internal Medicine, University of Kentucky, Lexington, KY.
David
D
Mannino
Department of Internal Medicine, University of Kentucky, Lexington, KY.
Andrew
A
Hoellein
Bluegrass Orthopeadics and Hand Care, Lexington, KY.
Ryan P
RP
Donegan
Vanderbilt University, Nashville, TN.
Leslie J
LJ
Crofford
D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000601:surgery*; D019643:Arthroplasty, Replacement; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D000072228:Arthroplasty, Replacement, Shoulder; D016022:Case-Control Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006073:Gout / Q000188:drug therapy / Q000453:epidemiology; D006074:Gout Suppressants / Q000627:therapeutic use; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D010003:Osteoarthritis / Q000453:epidemiology / Q000601:surgery*; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery; D011241:Prednisone / Q000627:therapeutic use; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012785:Shoulder Joint / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology*
D005938:Glucocorticoids; D006074:Gout Suppressants; D007166:Immunosuppressive Agents; D000493:Allopurinol; D011241:Prednisone
Case–control study; Immunosuppressive medications; Infections; Perioperative management; Risk factors; Total joint arthroplasty
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