Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements
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Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements. / Schrama, J. C.; Fenstad, A. M.; Dale, H.; Havelin, L.; Hallan, G.; Overgaard, Søren; Pedersen, A. B.; Karrholm, J.; Garellick, G.; Pulkkinen, P.; Eskelinen, A.; Makela, K.; Engesaeter, L. B.; Fevang, B. T.
In: Acta Orthopaedica (Print Edition), Vol. 86, No. 4, 2015, p. 469-476.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements
AU - Schrama, J. C.
AU - Fenstad, A. M.
AU - Dale, H.
AU - Havelin, L.
AU - Hallan, G.
AU - Overgaard, Søren
AU - Pedersen, A. B.
AU - Karrholm, J.
AU - Garellick, G.
AU - Pulkkinen, P.
AU - Eskelinen, A.
AU - Makela, K.
AU - Engesaeter, L. B.
AU - Fevang, B. T.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
U2 - 10.3109/17453674.2015.1017793
DO - 10.3109/17453674.2015.1017793
M3 - Journal article
C2 - 25782042
VL - 86
SP - 469
EP - 476
JO - Acta Orthopaedica
JF - Acta Orthopaedica
SN - 1745-3674
IS - 4
ER -
ID: 252057252