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DOS Kongressen 2017 ·
177
Risk of revision, prosthetic joint infection and
death following total hip or total knee arthroplasty
in patients with rheumatoid arthritis – a nationwide
cohort study from Denmark
René Cordtz, Pil Højgaard, Lars Erik Kristensen, Søren Overgaard, Anders Odgaard,
Hanne Lindegaard, Lene Dreyer
Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and
Spine Diseases, Rigshospitalet; The Parker Institute, Bispebjerg and Frederiksberg
Hospital; The Parker Institute, Bispebjerg and Frederiksberg Hospital; Department
of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department
of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte; Depart-
ment of Rheumatology, Odense University Hospital; Department of Rheumatology,
Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet
Background:
Previous studies have implied that rheumatoid arthritis (RA) patients
are at increased risk of prosthetic joint infection (PJI) but not death following total
hip and total knee arthroplasty (THA and TKA, respectively). Biological disease mod-
ifying anti-rheumatic drugs (bDMARDs) can halt the development of joint erosions
in RA, but it is unknown if they affect risks of revision, PJI and death.
Purpose / Aim of Study:
To investigate risk of revision (10-year), PJI (1-year)
and death (1-year) following THA/TKA in 1) RA compared with osteoarthritis (OA)
patients; and 2) bDMARD compared with non-bDMARD treated RA patients.
Materials and Methods:
To investigate risk of revision (10-year), PJI (1-year) and
death (1-year) following THA/TKA in 1) RA compared with osteoarthritis (OA) pa-
tients; and 2) bDMARD compared with non-bDMARD treated RA patients.
Findings / Results:
We identified 3913 RA and 120,499 OA patients. RA patients
had decreased SHR for revision (0.71; 95%CI 0.57-0.89), but increased SHR for PJI
(1.84; 95%CI 1.55- 2.18) and HR for death (1.58; 95%CI 1.47- 1.69) compared
with OA patients. In DANBIO, 345 of 1946 registered RA patients with THA/TKA
received a bDMARD within 90 days before surgery. These patients did not have a
statistically significant increased SHR for PJI (1.61; 95%CI 0.70-3.69) nor HR for
death (0.75; 95%CI 0.24-2.33) compared with non- bDMARD treated.
Conclusions:
We found an increased risk of PJI and death in RA compared with OA
patients following THA/TKA. bDMARD exposure was not associated with statisti-
cally significant increased risks of PJI nor death; however, estimates were numeri-
cally increased and more studies are needed to confirm no excessive risk exists.
No conflicts of interest reported
129.