Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

J. C. Schrama, A. M. Fenstad, H. Dale, L. Havelin, G. Hallan, Søren Overgaard, A. B. Pedersen, J. Karrholm, G. Garellick, P. Pulkkinen, A. Eskelinen, K. Makela, L. B. Engesaeter, B. T. Fevang

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

108 Downloads (Pure)

Resumé

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.
OriginalsprogEngelsk
TidsskriftActa Orthopaedica (Print Edition)
Vol/bind86
Udgave nummer4
Sider (fra-til)469-476
ISSN1745-3674
DOI
StatusUdgivet - 2015

Emneord

  • adult aged article bone necrosis/su [Surgery] *cementless prosthesis ceramics death female femur head follow up hip disease/su [Surgery] hip osteoarthritis/su [Surgery] human major clinical study male prosthesis failure/co [Complication] prosthesis loosening/co [Complication] *total hip prosthesis metal polyethylene

Citer dette

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. / Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements. I: Acta Orthopaedica (Print Edition). 2015 ; Bind 86, Nr. 4. s. 469-476.
@article{8e5a5995d49a473ab788f529c0868344,
title = "Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements",
abstract = "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.",
keywords = "adult aged article bone necrosis/su [Surgery] *cementless prosthesis ceramics death female femur head follow up hip disease/su [Surgery] hip osteoarthritis/su [Surgery] human major clinical study male prosthesis failure/co [Complication] prosthesis loosening/co [Complication] *total hip prosthesis metal polyethylene",
author = "Schrama, {J. C.} and Fenstad, {A. M.} and H. Dale and L. Havelin and G. Hallan and S{\o}ren Overgaard and Pedersen, {A. B.} and J. Karrholm and G. Garellick and P. Pulkkinen and A. Eskelinen and K. Makela and Engesaeter, {L. B.} and Fevang, {B. T.}",
year = "2015",
doi = "10.3109/17453674.2015.1017793",
language = "English",
volume = "86",
pages = "469--476",
journal = "Acta Orthopaedica (Print Edition)",
issn = "1745-3674",
publisher = "Taylor & Francis",
number = "4",

}

Schrama, JC, Fenstad, AM, Dale, H, Havelin, L, Hallan, G, Overgaard, S, Pedersen, AB, Karrholm, J, Garellick, G, Pulkkinen, P, Eskelinen, A, Makela, K, Engesaeter, LB & Fevang, BT 2015, 'Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements', Acta Orthopaedica (Print Edition), bind 86, nr. 4, s. 469-476. https://doi.org/10.3109/17453674.2015.1017793

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.

I: Acta Orthopaedica (Print Edition), Bind 86, Nr. 4, 2015, s. 469-476.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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.

KW - adult aged article bone necrosis/su [Surgery] cementless prosthesis ceramics death female femur head follow up hip disease/su [Surgery] hip osteoarthritis/su [Surgery] human major clinical study male prosthesis failure/co [Complication] prosthesis looseni

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 (Print Edition)

JF - Acta Orthopaedica (Print Edition)

SN - 1745-3674

IS - 4

ER -