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Anti-rheumatic treatment and prosthetic joint infection : An observational study in 494 elective hip and knee arthroplasties

Borgas, Ylva ; Gülfe, Anders LU ; Kindt, Mikael and Stefánsdóttir, Anna LU (2020) In BMC Musculoskeletal Disorders 21(1).
Abstract

Background: Surgical site infections are more frequent among patients with rheumatic disease. To what extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively. The aim of study was to assess the rate of surgical site infections after knee and hip replacement in patients with inflammatory joint disease, with an emphasis on periprosthetic joint infection, and to investigate the influence of treatment with disease-modifying antirheumatic drugs (DMARDs) in this regard. Methods: Data were collected from 494 primary elective hip (51.4%) and knee arthroplasties, along with demographic and medication data. The primary outcome was surgical site infection during the... (More)

Background: Surgical site infections are more frequent among patients with rheumatic disease. To what extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively. The aim of study was to assess the rate of surgical site infections after knee and hip replacement in patients with inflammatory joint disease, with an emphasis on periprosthetic joint infection, and to investigate the influence of treatment with disease-modifying antirheumatic drugs (DMARDs) in this regard. Methods: Data were collected from 494 primary elective hip (51.4%) and knee arthroplasties, along with demographic and medication data. The primary outcome was surgical site infection during the first year after surgery. Results: In 78% (n = 385) of the cases the patient used 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty-two percent (n = 157) of patients used a TNF-alpha inhibitor. The rate of surgical site infection was 3.8% (n = 19). The rate of periprosthetic joint infection was 1.4% (n = 7), all of which occurred after knee arthroplasty. Periprosthetic joint infection occurred in only 1 patient medicating perioperatively with a TNF-alpha inhibitor. Conclusion: Surgical site infections were not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to the low event rate this should be interpreted with caution, but our center will maintain its routine of continuing treatment with TNF-alpha inhibitors perioperatively.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anti-TNF, bDMARD, Infections, Orthopedic surgery
in
BMC Musculoskeletal Disorders
volume
21
issue
1
article number
410
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85087386042
  • pmid:32600315
ISSN
1471-2474
DOI
10.1186/s12891-020-03459-z
language
English
LU publication?
yes
id
4b1576d9-a9f3-4fb5-83f3-f640f121446a
date added to LUP
2020-07-16 10:42:03
date last changed
2020-07-22 04:22:00
@article{4b1576d9-a9f3-4fb5-83f3-f640f121446a,
  abstract     = {<p>Background: Surgical site infections are more frequent among patients with rheumatic disease. To what extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively. The aim of study was to assess the rate of surgical site infections after knee and hip replacement in patients with inflammatory joint disease, with an emphasis on periprosthetic joint infection, and to investigate the influence of treatment with disease-modifying antirheumatic drugs (DMARDs) in this regard. Methods: Data were collected from 494 primary elective hip (51.4%) and knee arthroplasties, along with demographic and medication data. The primary outcome was surgical site infection during the first year after surgery. Results: In 78% (n = 385) of the cases the patient used 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty-two percent (n = 157) of patients used a TNF-alpha inhibitor. The rate of surgical site infection was 3.8% (n = 19). The rate of periprosthetic joint infection was 1.4% (n = 7), all of which occurred after knee arthroplasty. Periprosthetic joint infection occurred in only 1 patient medicating perioperatively with a TNF-alpha inhibitor. Conclusion: Surgical site infections were not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to the low event rate this should be interpreted with caution, but our center will maintain its routine of continuing treatment with TNF-alpha inhibitors perioperatively.</p>},
  author       = {Borgas, Ylva and Gülfe, Anders and Kindt, Mikael and Stefánsdóttir, Anna},
  issn         = {1471-2474},
  language     = {eng},
  month        = {06},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Musculoskeletal Disorders},
  title        = {Anti-rheumatic treatment and prosthetic joint infection : An observational study in 494 elective hip and knee arthroplasties},
  url          = {http://dx.doi.org/10.1186/s12891-020-03459-z},
  doi          = {10.1186/s12891-020-03459-z},
  volume       = {21},
  year         = {2020},
}