Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

Mar 18, 2015Acta orthopaedica

Higher risk of infection-related hip replacement problems in rheumatoid arthritis patients

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Abstract

Rheumatoid arthritis patients have a 1.3 times higher risk of revision for infection after total hip replacement compared to osteoarthritis patients.

The risk of revision for infection in rheumatoid arthritis patients increased more after 2001 compared to osteoarthritis patients.
Higher infection revision rates were observed in rheumatoid arthritis patients during the first 3 months and from 8 years postoperatively.
Total hip replacements in rheumatoid arthritis patients using antibiotic-loaded cement showed increased risks of early and late infection revisions compared to those in osteoarthritis patients.

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BACKGROUND AND PURPOSE: Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year period, and compared it with that in THR patients with osteoarthritis (OA).

PATIENTS AND METHODS: We identified 13,384 THRs in RA patients and 377,287 THRs in OA patients from 1995 through 2010 in a dataset from the Nordic Arthroplasty Register Association (NARA). Kaplan-Meier survival curves, with revision for infection as the endpoint, were constructed. Cox regression analyses were performed to calculate the relative risk (RR) of revision for infection adjusted for age, sex, fixation technique, and year of primary surgery.

RESULTS: RA patients had a 1.3 times (95% CI 1.0-1.6) higher risk of revision for infection. After 2001, this risk increased more for RA patients than for OA patients. During the first 3 months and from 8 years postoperatively, the risk of revision for infection was higher in RA patients with THRs fixated with antibiotic-loaded cement than in corresponding OA patients.

INTERPRETATION: We found a slightly higher overall risk of revision for infection in RA patients than in OA patients, but this difference was only present after 2001. In THRs with antibiotic-loaded cement, the risk of very early and late infections leading to revision was higher in RA patients than in OA patients.

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Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

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