Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 12, pp 3800–3807 | Cite as

Infection and revision rates following primary total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis: a meta-analysis

  • Do-Kyung Lee
  • Hyun-Jung Kim
  • Il-Youp Cho
  • Dae-Hee LeeEmail author
Knee

Abstract

Purpose

This meta-analysis compared infection and revision rates in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent total knee arthroplasty (TKA). Rates of superficial wound and deep periprosthetic infections were compared in the groups, as were whether revision rates associated with infectious and noninfectious causes differed in the RA and OA groups.

Methods

Studies were included in the meta-analysis if they (1) compared infection and revision rates after primary TKA in RA and OA patients; (2) directly compared superficial wound and deep periprosthetic infection rates in RA and OA patients who underwent primary TKA; and (3) reported the actual numbers of RA and OA patients who underwent TKA and developed postoperative infection and/or required revision.

Results

The rate of superficial wound infections after primary TKA was similar in the RA and OA groups (15/258 [5.8 %] vs. 77/1609 [4.7 %]; odds ratio [OR] 1.12, 95 % confidence interval [CI] 0.36–3.46; P = n.n.), but the deep infection rate was significantly higher in RA than in OA patients (229/7651 [3.0 %] vs. 642/68628 [0.9 %]; OR 2.04, 95 % CI 1.37–3.05; P < 0.001). The proportion of subjects who required revision resulting from infection after TKA was significantly higher in the RA than in the OA group (86/8201 [1.0 %] vs. 555/118755 [0.5 %]; OR 1.89, 95 % CI 1,34–2.66; P < 0.001), whereas the proportion of subjects requiring revision due to noninfectious causes did not differ significantly (46/594 [7.7 %] vs. 52/904 [5.7 %]; OR 1.22, 95 % CI 0.74–2.00; P = n.n.)

Conclusion

Following primary TKA, RA patients had a significantly higher rate of deep periprosthetic infections than OA patients, but their superficial infection rates were similar. The revision rate due to infectious causes was significantly higher in RA than in OA patients, but their revision rates due to noninfectious causes did not differ. Therefore, the surgeon should fully explain to RA patients scheduled to undergo primary TKA that, compared to OA patients, they are more likely to experience a deep infection postsurgery.

Level of evidence

Meta-analysis Level III.

Keywords

Rheumatoid arthritis Osteoarthritis Infection Revision Total knee arthroplasty Meta-analysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funds were received to do this research.

Ethical approval

There were no ethical approval, because this study was a meta-analysis based on the data of previously published studies.

Informed consent

Informed consent was not applicable since the study design was a meta-analysis.

References

  1. 1.
    Bengtson S, Knutson K (1991) The infected knee arthroplasty. A 6-year follow-up of 357 cases. Acta Orthop Scand 62:301–311CrossRefPubMedGoogle Scholar
  2. 2.
    Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81:2–10CrossRefPubMedGoogle Scholar
  3. 3.
    Bongartz T, Halligan CS, Osmon DR, Reinalda MS, Bamlet WR, Crowson CS, Hanssen AD, Matteson EL (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 59:1713–1720CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Carson JL, Altman DG, Duff A, Noveck H, Weinstein MP, Sonnenberg FA, Hudson JI, Provenzano G (1999) Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair. Transfusion (Paris) 39:694–700CrossRefGoogle Scholar
  5. 5.
    Chesney D, Sales J, Elton R, Brenkel IJ (2008) Infection after knee arthroplasty a prospective study of 1509 cases. J Arthroplasty 23:355–359CrossRefPubMedGoogle Scholar
  6. 6.
    Choi YJ, Ra HJ (2016) Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 28:1–15CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    da Cunha BM, de Oliveira SB, Santos-Neto L (2011) Incidence of infectious complications in hip and knee arthroplasties in rheumatoid arthritis and osteoarthritis patients. Rev Bras Reumatol 51:609–615CrossRefPubMedGoogle Scholar
  8. 8.
    da Silva E, Doran MF, Crowson CS, O’Fallon WM, Matteson EL (2003) Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long-term, population-based assessment. Arthritis Rheum 49:216–220CrossRefPubMedGoogle Scholar
  9. 9.
    Elke R, Meier G, Warnke K, Morscher E (1995) Outcome analysis of total knee-replacements in patients with rheumatoid arthritis versus osteoarthritis. Arch Orthop Trauma Surg 114:330–334CrossRefPubMedGoogle Scholar
  10. 10.
    Emery P (2002) Evidence supporting the benefit of early intervention in rheumatoid arthritis. J Rheumatol Suppl 66:3–8PubMedGoogle Scholar
  11. 11.
    Goldberg VM (2001) Principles of revision total knee arthroplasty: overview. Instr Course Lect 50:357–358PubMedGoogle Scholar
  12. 12.
    Jamsen E, Huhtala H, Puolakka T, Moilanen T (2009) Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am 91:38–47CrossRefPubMedGoogle Scholar
  13. 13.
    Kapetanovic MC, Lindqvist E, Saxne T, Eberhardt K (2008) Orthopaedic surgery in patients with rheumatoid arthritis over 20 years: prevalence and predictive factors of large joint replacement. Ann Rheum Dis 67:1412–1416CrossRefPubMedGoogle Scholar
  14. 14.
    Korpela M, Laasonen L, Hannonen P, Kautiainen H, Leirisalo-Repo M, Hakala M, Paimela L, Blafield H, Puolakka K, Mottonen T, Group FI-RT (2004) Retardation of joint damage in patients with early rheumatoid arthritis by initial aggressive treatment with disease-modifying antirheumatic drugs: five-year experience from the FIN-RACo study. Arthritis Rheum 50:2072–2081CrossRefGoogle Scholar
  15. 15.
    Laskin RS, O’Flynn HM (1997) The Insall Award. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications. Clin Orthop Relat Res 345:24–28CrossRefGoogle Scholar
  16. 16.
    Lee BJ, Kyung HS, Yoon SD (2015) Two-stage revision for infected total knee arthroplasty: based on autoclaving the recycled femoral component and intraoperative molding using antibiotic-impregnated cement on the tibial side. Clin Orthop Surg 7:310–317CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    LoVerde ZJ, Mandl LA, Johnson BK, Figgie MP, Boettner F, Lee YY, Goodman SM (2015) Rheumatoid arthritis does not increase risk of short-term adverse events after total knee arthroplasty: a retrospective case-control study. J Rheumatol 42:1123–1130CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Mertelsmann-Voss C, Lyman S, Pan TJ, Goodman SM, Figgie MP, Mandl LA (2014) US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis. Arthritis Rheumatol 66:1432–1439CrossRefPubMedGoogle Scholar
  19. 19.
    Nafei A, Kristensen O, Knudsen HM, Hvid I, Jensen J (1996) Survivorship analysis of cemented total condylar knee arthroplasty. A long-term follow-up report on 348 cases. J Arthroplasty 11:7–10CrossRefPubMedGoogle Scholar
  20. 20.
    Partio E, Orava T, Lehto MU, Lindholm ST (1994) Survival of the Townley knee. 360 cases with 8 (0.1-15) years’ follow-up. Acta Orthop Scand 65:319–322CrossRefPubMedGoogle Scholar
  21. 21.
    Ravi B, Croxford R, Hollands S, Paterson JM, Bogoch E, Kreder H, Hawker GA (2014) Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis. Arthritis Rheumatol 66:254–263CrossRefPubMedGoogle Scholar
  22. 22.
    Ravi B, Escott B, Shah PS, Jenkinson R, Chahal J, Bogoch E, Kreder H, Hawker G (2012) A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum 64:3839–3849CrossRefPubMedGoogle Scholar
  23. 23.
    Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, Cremers S, Abraham IL, Investigation O (2003) Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion (Paris) 43:459–469CrossRefGoogle Scholar
  24. 24.
    Schnaser EA, Browne JA, Padgett DE, Figgie MP, D’Apuzzo MR (2015) Perioperative complications in patients with inflammatory arthropathy undergoing total knee arthroplasty. J Arthroplasty 30:76–80CrossRefPubMedGoogle Scholar
  25. 25.
    Schrama JC, Espehaug B, Hallan G, Engesaeter LB, Furnes O, Havelin LI, Fevang BT (2010) Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: a prospective, population-based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register. Arthritis Care Res (Hoboken) 62:473–479CrossRefGoogle Scholar
  26. 26.
    Singh JA, Inacio MC, Namba RS, Paxton EW (2015) Rheumatoid arthritis is associated with higher ninety-day hospital readmission rates compared to osteoarthritis after hip or knee arthroplasty: a cohort study. Arthritis Care Res (Hoboken) 67:718–724CrossRefGoogle Scholar
  27. 27.
    Stundner O, Danninger T, Chiu YL, Sun X, Goodman SM, Russell LA, Figgie M, Mazumdar M, Memtsoudis SG (2014) Rheumatoid arthritis vs osteoarthritis in patients receiving total knee arthroplasty: perioperative outcomes. J Arthroplasty 29:308–313CrossRefPubMedGoogle Scholar
  28. 28.
    Tayton ER, Frampton C, Hooper GJ, Young SW (2016) The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty: an analysis of 64 566 joints from the New Zealand Joint Registry. Bone Joint J 98-B:334–340CrossRefPubMedGoogle Scholar
  29. 29.
    Watanabe T, Muneta T, Koga H, Horie M, Nakamura T, Otabe K, Nakagawa Y, Katakura M, Sekiya I (2016) In-vivo kinematics of high-flex posterior-stabilized total knee prosthesis designed for Asian populations. Int Orthop. doi: 10.1007/s00264-016-3176-5 Google Scholar
  30. 30.
    Weir DJ, Moran CG, Pinder IM (1996) Kinematic condylar total knee arthroplasty. 14-year survivorship analysis of 208 consecutive cases. J Bone Joint Surg Br 78:907–911CrossRefPubMedGoogle Scholar
  31. 31.
    Wolfe F, Zwillich SH (1998) The long-term outcomes of rheumatoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis. Arthritis Rheum 41:1072–1082CrossRefPubMedGoogle Scholar
  32. 32.
    Zurcher-Pfund L, Uckay I, Legout L, Gamulin A, Vaudaux P, Peter R (2013) Pathogen-driven decision for implant retention in the management of infected total knee prostheses. Int Orthop 37:1471–1475CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Do-Kyung Lee
    • 1
  • Hyun-Jung Kim
    • 2
  • Il-Youp Cho
    • 3
  • Dae-Hee Lee
    • 1
    Email author
  1. 1.Department of Orthopaedic Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineGangnam-Gu, SeoulKorea
  2. 2.Department of Preventive MedicineKorea University College of MedicineSeoulKorea
  3. 3.Department of Orthopedic SurgeryKorea University Anam Hospital, Korea University College of MedicineSeoulKorea

Personalised recommendations