with rheumatoid arthritis (RA) have more complications after total joint
arthroplasty (TJA) than patients with osteoarthritis (OA) and are at notably
higher risk for dislocation of replaced hip joints, according to a Medscape Medical News article based on a
systematic review published online November 28 in Arthritis
The analysis included 40 reports published between 1990 and 2011 that
describe primary TJA of the hip or knee in patients with RA (n = 2,842) or OA
(n = 61,861). Outcomes included revision, hip dislocation, infection, 90-day
mortality, and venous thromboembolic events.
The researchers found that patients with RA had double the risk for hip
dislocation after total hip arthroplasty compared with patients with OA.
Adjustments were made for age, sex, surgical approach, and surgeon's volume.
Infection risk was up to a 10-fold increase in patients with RA after total
knee arthroplasty, particularly in patients with prior infection in the
replaced joint, prior infection in any joint, or longer duration of operating.
There was no association between infection risk and perioperative systemic
corticosteroid use or withdrawal of biologic treatment before surgery. However,
meta-analysis was not completed due to variable definitions of infection and
preoperative antibiotic protocols, the article says.
Johannes Cornelis Schrama, MD, who was not involved in the study, told Medscape Medical News that that the
researchers do not appear to have overlooked any major factors in their
analysis, but he was cautious about possible clinical application. "It is
difficult to define clinical implications other than possible preventive
measures [against infection] in patients undergoing [total knee
arthroplasty]," he said.
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