Risk Factors for Infection Following Total Joint Arthroplasty in Rheumatoid Arthritis



Ranjani Somayaji1, Cheryl Barnabe*, 1, 2, Liam Martin1
1 Department of Medicine, Health Sciences, University of Calgary, Calgary, Alberta, Canada
2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada


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© Somayaji et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the 3330 Hospital Dr. NW, Calgary, AB CANADA T2N 4N1, Canada; Tel: (403) 220-7725; Fax: (403) 283-5666; E-mail: ccbarnab@ucalgary.ca


Abstract

Objectives:

Determine risk factors for infection following hip or knee total joint arthroplasty in patients with rheumatoid arthritis.

Methods:

All rheumatoid arthritis patients with a hip or knee arthroplasty between years 2000 and 2010 were identified from population-based administrative data from the Calgary Zone of Alberta Health Services. Clinical data from patient charts during the hospital admission and during a one year follow-up period were extracted to identify incident infections.

Results:

We identified 381 eligible procedures performed in 259 patients (72.2% female, mean age 63.3 years, mean body mass index 27.6 kg/m2). Patient comorbidities were hypertension (43.2%), diabetes (10.4%), coronary artery disease (13.9%), smoking (10.8%) and obesity (32%). Few infectious complications occurred: surgical site infections occurred within the first year after 5 procedures (2 joint space infections, 3 deep incisional infections). Infections of non-surgical sites (urinary tract, skin or respiratory, n=4) complicated the hospital admission. The odds ratio for any post-arthroplasty infection was increased in patients using prednisone doses exceeding 15 mg/day (OR 21.0, 95%CI 3.5-127.2, p=<0.001), underweight patients (OR 6.0, 95%CI 1.2-30.9, p=0.033) and those with known coronary artery disease (OR 5.1, 95%CI 1.3-19.8, p=0.017). Types of disease-modifying therapy, age, sex, and other comorbidities were not associated with an increased risk for infection.

Conclusion:

Steroid doses over 15 mg/day, being underweight and having coronary artery disease were associated with significant increases in the risk of post-arthroplasty infection in rheumatoid arthritis. Maximal tapering of prednisone and comorbidity risk reduction must be addressed in the peri-operative management strategy.

Keywords: : Rheumatoid arthritis, infections, arthroplasty, administrative data..