title: Risk factors for late deep infection after total hip arthroplasty in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Postoperative infections, a serious complication of orthopedic surgery, occur 2-4 times more frequently in patients with rheumatoid arthritis (RA) without adjustment for medication. Some studies have demonstrated a similar risk of postoperative infection following orthopedic surgery regardless of whether patients underwent tumor necrosis factor-α (TNF-α) inhibitor therapy; however, other studies have reported a higher risk with TNF-α inhibitor use. However, few reports have focused on the correlation between TNF-α inhibitor use and postoperative late infection. Therefore, we investigated the correlation between TNF-α inhibitor therapy and serious postoperative late infection in patients with RA who underwent total hip arthroplasty (THA).
  
  
  METHODS
  Ninety-nine patients with RA who were enrolled in our institution's and Konan Kakogawa Hospital's THA registry between January 2003 and December 2012 were eligible to participate. Data collected included clinical parameters and medications, including biological drugs, disease-modifying antirheumatic drugs, and glucocorticoids. Logistic regression analysis was performed to examine the association between clinical parameters, medications, and the development of postoperative late infection.
  
  
  RESULTS
  One risk factor was identified in the multivariate analysis. TNF inhibitor therapy was found to be significantly associated with the development of late infection after THA (biological drugs: OR: 9.5, 95% CI: 1.0-88.8; TNF inhibitor: OR: 11.7, 95% CI: 1.2-109.7).
  
  
  CONCLUSIONS
  Biological drug therapy, especially TNF inhibitors, may be associated with an increased rate of late deep infection after THA. When the use of TNF-α inhibitor therapy is considered, rheumatologists must be attentive to patients after THA.
authors.affiliation: Kobe University Graduate School of Medicine.
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Kobe University Graduate School of Medicine.
authors.forename: Shingo
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: Kobe University Graduate School of Medicine.
authors.forename: Koji
authors.initials: K
authors.lastname: Takayama
authors.affiliation: Kobe University Graduate School of Medicine.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Konan Kakogawa Hospital.
authors.forename: Ken
authors.initials: K
authors.lastname: Takebe
authors.affiliation: Konan Kakogawa Hospital.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Terashima
authors.affiliation: Kobe University Graduate School of Medicine.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kuroda
authors.affiliation: Kobe University Graduate School of Medicine.
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Kobe Kaisei Hospital.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Kobe University Graduate School of Medicine.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nishida
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors