Skip to main content

Advertisement

SpringerLink
Log in

More complications and higher transfusion rate in patients with rheumatoid arthritis than osteoarthritis undergoing total hip arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) has been associated with an increased risk of periprosthetic joint infection, periprosthetic fractures, dislocations, and post-operative blood transfusion. However, higher post-operative blood transfusion is unclear whether it reflects peri-operative blood loss or is characteristic of RA. This study aimed to compare the complications, allogenic blood transfusion, albumin use, and peri-operative blood loss between patients who underwent THA because of RA or osteoarthritis (OA).

Methods

Patients undergoing cementless THA for hip RA (n = 220) or hip OA (n = 261) at our hospital between 2011 and 2021 were retrospectively enrolled. Deep vein thrombosis, pulmonary embolism, myocardial infarction, calf muscular venous thrombosis, wound complications, deep prosthetic infection, hip prosthesis dislocation, periprosthetic fractures, 30-day mortality, 90-day readmission, allogeneic blood transfusion, and albumin infusions were considered as primary outcomes, while secondary outcomes included the number of perioperative anaemia patients as well as total, intra-operative, and hidden blood loss.

Results

Compared to the OA group, patients with hip RA showed significantly higher rates of wound aseptic complications, hip prosthesis dislocation, homologous transfusion, and albumin use. RA patients also showed a significantly higher prevalence of pre-operative anemia. However, no significant differences were observed between the two groups in total, intra-operative, or hidden blood loss.

Conclusions

Our study suggests that RA patients undergoing THA are at a higher risk of wound aseptic complications and hip prosthesis dislocation than patients with hip OA. Pre-operative anaemia and hypoalbuminaemia in patients with hip RA place them at a significantly higher risk of post-operative blood transfusion and use of albumin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Świtoń A, Wodka-Natkaniec E, Niedźwiedzki Ł, Gaździk T, Niedźwiedzki T (2017) Activity and quality of life after total hip arthroplasty. Ortop Traumatol Rehabil 19:441–450

    Article  PubMed  Google Scholar 

  2. Carling MS, Jeppsson A, Eriksson BI, Brisby H (2015) Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study. J Orthop Surg Res 10:48. https://doi.org/10.1186/s13018-015-0188-6

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zhou VY et al (2022) Has the incidence of total joint arthroplasty in rheumatoid arthritis decreased in the era of biologics use? A population-based cohort study. Rheumatology (Oxford) 61:1819–1830. https://doi.org/10.1093/rheumatology/keab643

    Article  PubMed  Google Scholar 

  4. Lee Y-H, Ko P-Y, Kao S-L, Lin M-C, Cheng-Chung Wei J (2020) Risk of total knee and hip arthroplasty in patients with rheumatoid arthritis: a 12-year retrospective cohort study of 65,898 patients. J Arthroplasty 35:3517–3523. https://doi.org/10.1016/j.arth.2020.06.085

    Article  PubMed  Google Scholar 

  5. van der Woude D, van der Helm-van Mil AHM (2018) Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best Pract Res Clin Rheumatol 32:174–187. https://doi.org/10.1016/j.berh.2018.10.005

    Article  PubMed  Google Scholar 

  6. Kurtz SM et al (2017) Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty? Clin Orthop Relat Res 475:2926–2937. https://doi.org/10.1007/s11999-017-5244-6

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cordtz R, Odgaard A, Kristensen LE, Overgaard S, Dreyer L (2020) Risk of medical complications following total hip or knee arthroplasty in patients with rheumatoid arthritis: a register-based cohort study from Denmark. Semin Arthritis Rheum 50:30–35. https://doi.org/10.1016/j.semarthrit.2019.06.007

    Article  PubMed  Google Scholar 

  8. Ravi B et al (2014) Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis. Arthritis Rheumatol 66:254–263. https://doi.org/10.1002/art.38231

    Article  PubMed  Google Scholar 

  9. Stundner O et al (2014) Rheumatoid arthritis vs osteoarthritis in patients receiving total knee arthroplasty: perioperative outcomes. J Arthroplasty 29:308–313. https://doi.org/10.1016/j.arth.2013.05.008

    Article  PubMed  Google Scholar 

  10. Stundner O et al (2013) Perioperative outcomes in patients with rheumatoid versus osteoarthritis for total hip arthroplasty: a population-based study. Clin Exp Rheumatol 31:889–895

    PubMed  Google Scholar 

  11. Ravi B et al (2014) Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty. Arthritis Rheumatol 66:488–496. https://doi.org/10.1002/art.38205

    Article  PubMed  Google Scholar 

  12. Morse KW et al (2020) Tranexamic acid does not reduce the risk of transfusion in rheumatoid arthritis patients undergoing total joint arthroplasty. J Arthroplasty 35:2367–2374. https://doi.org/10.1016/j.arth.2020.04.029

    Article  PubMed  Google Scholar 

  13. Wilson A, Yu H-T, Goodnough LT, Nissenson AR (2004) Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. Am J Med 116 Suppl 7A:50S-57S

    Article  PubMed  Google Scholar 

  14. Weber EWG et al (2005) Perioperative blood transfusions and delayed wound healing after hip replacement surgery: effects on duration of hospitalization. Anesth Analg 100:1416–1421. https://doi.org/10.1213/01.ANE.0000150610.44631.9D

    Article  PubMed  Google Scholar 

  15. Stanworth SJ et al (2011) A national study of plasma use in critical care: clinical indications, dose and effect on prothrombin time. Crit Care 15:R108. https://doi.org/10.1186/cc10129

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232

    PubMed  Google Scholar 

  18. Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280

    Article  CAS  PubMed  Google Scholar 

  19. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity (2021) World Health Organization: https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1. Accessed 31 May 2011

  20. Technical specifications of clinical blood transfusion (2001) National health Commission of the People’s Republic of China: http://www.nhc.gov.cn/wjw/gfxwj/200111/2c93606209ec4a25ad9241787f9f7404.shtml. Accessed 8 Nov 2001

  21. Carroll K, Dowsey M, Choong P, Peel T (2014) Risk factors for superficial wound complications in hip and knee arthroplasty. Clin Microbiol Infect 20:130–135. https://doi.org/10.1111/1469-0691.12209

    Article  CAS  PubMed  Google Scholar 

  22. Feldmann M, Maini SRN (2008) Role of cytokines in rheumatoid arthritis: an education in pathophysiology and therapeutics. Immunol Rev 223. https://doi.org/10.1111/j.1600-065X.2008.00626.x

  23. Rapala K (1996) The effect of tumor necrosis factor-alpha on wound healing. An experimental study. Ann Chir Gynaecol Suppl 211:1–53

    CAS  PubMed  Google Scholar 

  24. Anstead GM (1998) Steroids, retinoids, and wound healing. Adv Wound Care 11:277–285

    CAS  PubMed  Google Scholar 

  25. Rapala K et al (1997) Tumour necrosis factor-alpha selectivity modulates expression of collagen genes in rat granulation tissue. Eur J Surg 163:207–214

    CAS  PubMed  Google Scholar 

  26. Maish GO, Shumate ML, Ehrlich HP, Vary TC, Cooney RN (1999) Interleukin-1 receptor antagonist attenuates tumor necrosis factor-induced alterations in wound breaking strength. J Trauma 47:533–537

    Article  CAS  PubMed  Google Scholar 

  27. Ismael H et al (2011) Adverse effects of preoperative steroid use on surgical outcomes. Am J Surg 201. https://doi.org/10.1016/j.amjsurg.2010.09.018

  28. Kittle H, Ormseth A, Patetta MJ, Sood A, Gonzalez MH (2020) Chronic corticosteroid use as a risk factor for perioperative complications in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg Glob Res Rev 4:e2000001. https://doi.org/10.5435/JAAOSGlobal-D-20-00001

    Article  PubMed  Google Scholar 

  29. Boddapati V et al (2018) Preoperative corticosteroid use for medical conditions is associated with increased postoperative infectious complications and readmissions after total hip arthroplasty: a propensity-matched study. Am J Orthop (Belle Mead NJ) 47. https://doi.org/10.12788/ajo.2018.0104

  30. Conroy JL et al (2008) Risk factors for revision for early dislocation in total hip arthroplasty. J Arthroplasty 23:867–872. https://doi.org/10.1016/j.arth.2007.07.009

    Article  PubMed  Google Scholar 

  31. Khatod M, Barber T, Paxton E, Namba R, Fithian D (2006) An analysis of the risk of hip dislocation with a contemporary total joint registry. Clin Orthop Relat Res 447:19–23

    Article  PubMed  Google Scholar 

  32. Chevalier T et al (2018) Body mass prediction from femoral volume and sixteen other femoral variables in the elderly: BMI and adipose tissue effects. Am J Phys Anthropol 166:26–42. https://doi.org/10.1002/ajpa.23396

    Article  PubMed  Google Scholar 

  33. Hastings DE, Parker SM (1975) Protrusio acetabuli in rheumatoid arthritis. Clin Orthop Relat Res. 108:76–83. https://doi.org/10.1097/00003086-197505000-00012

    Article  Google Scholar 

  34. Mibe J, Imakiire A, Watanabe T, Fujie T (2005) Results of total hip arthroplasty with bone graft and support ring for protrusio acetabuli in rheumatoid arthritis. J Orthop Sci 10(1):8–14. https://doi.org/10.1007/s00776-004-0845-9

    Article  PubMed  Google Scholar 

  35. Zhu TY et al (2015) Cortical thinning and progressive cortical porosity in female patients with systemic lupus erythematosus on long-term glucocorticoids: a 2-year case-control study. Osteoporos Int 26:1759–1771. https://doi.org/10.1007/s00198-015-3077-2

    Article  CAS  PubMed  Google Scholar 

  36. Antoniadis A, Wegrzyn J (2022) Direct cementation of dual mobility cups into the bony acetabulum in primary total hip arthroplasty: clinical and radiographic outcomes at a minimum 5-year follow-up. J Arthroplasty. https://doi.org/10.1016/j.arth.2022.12.031

    Article  PubMed  Google Scholar 

  37. Ogbemudia AE, Yee SY, MacPherson GJ, Manson LM, Breusch SJ (2013) Preoperative predictors for allogenic blood transfusion in hip and knee arthroplasty for rheumatoid arthritis. Arch Orthop Trauma Surg 133:1315–1320. https://doi.org/10.1007/s00402-013-1784-8

    Article  PubMed  Google Scholar 

  38. Weiss G, Schett G (2013) Anaemia in inflammatory rheumatic diseases. Nat Rev Rheumatol 9:205–215. https://doi.org/10.1038/nrrheum.2012.183

    Article  CAS  PubMed  Google Scholar 

  39. Tański W, Chabowski M, Jankowska-Polańska B, Jankowska EA (2021) Iron metabolism in patients with rheumatoid arthritis. Eur Rev Med Pharmacol Sci 25:4325–4335. https://doi.org/10.26355/eurrev_202106_26140

    Article  PubMed  Google Scholar 

  40. Papadaki HA, Kritikos HD, Valatas V, Boumpas DT, Eliopoulos GD (2002) Anemia of chronic disease in rheumatoid arthritis is associated with increased apoptosis of bone marrow erythroid cells: improvement following anti-tumor necrosis factor-alpha antibody therapy. Blood 100:474–482

    Article  CAS  PubMed  Google Scholar 

  41. Maury CP, Andersson LC, Teppo AM, Partanen S, Juvonen E (1988) Mechanism of anaemia in rheumatoid arthritis: demonstration of raised interleukin 1 beta concentrations in anaemic patients and of interleukin 1 mediated suppression of normal erythropoiesis and proliferation of human erythroleukaemia (HEL) cells in vitro. Ann Rheum Dis 47:972–978

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Grosso MJ et al (2020) The effect of preoperative anemia on complications after total hip arthroplasty. J Arthroplasty 35:S214–S218. https://doi.org/10.1016/j.arth.2020.01.012

    Article  PubMed  Google Scholar 

  43. Corrado A, Di Bello V, d’Onofrio F, Maruotti N, Cantatore FP (2017) Anti-TNF-α effects on anemia in rheumatoid and psoriatic arthritis. Int J Immunopathol Pharmacol 30:302–307. https://doi.org/10.1177/0394632017714695

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Tsuji H et al (2020) Persistent anemia and hypoalbuminemia in rheumatoid arthritis patients with low serum triiodothyronine level. Mod Rheumatol 30:640–647. https://doi.org/10.1080/14397595.2019.1649109

    Article  CAS  PubMed  Google Scholar 

  45. Zhang S et al (2021) Incidence and risk factors associated with human albumin administration following total joint arthroplasty: a multicenter retrospective study. J Orthop Surg Res 16:643. https://doi.org/10.1186/s13018-021-02642-9

    Article  PubMed  PubMed Central  Google Scholar 

  46. Xu S et al (2019) Blood loss of posterior lumbar interbody fusion on lumbar stenosis in patients with rheumatoid arthritis: a case-control study. Spine (Phila Pa 1976) 44:E1045–E1052. https://doi.org/10.1097/BRS.0000000000003037

    Article  PubMed  Google Scholar 

  47. Pattison E, Protheroe K, Pringle RM, Kennedy AC, Dick WC (1973) Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis 32:582–584

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Erskine JG, Fraser C, Simpson R, Protheroe K, Walker ID (1981) Blood loss with knee joint replacement. J R Coll Surg Edinb 26:295–297

    CAS  PubMed  Google Scholar 

  49. Chen X-X, Wang T, Li J, Kang H (2016) Relationship between inflammatory response and estimated complication rate after total hip arthroplasty. Chin Med J (Engl) 129:2546–2551. https://doi.org/10.4103/0366-6999.192772

    Article  CAS  PubMed  Google Scholar 

  50. Lei Y, Huang Z, Huang Q, Huang W, Pei F (2020) Repeat doses of dexamethasone up to 48 hours further reduce pain and inflammation after total hip arthroplasty: a randomized controlled trial. J Arthroplasty 35:3223–3229. https://doi.org/10.1016/j.arth.2020.06.023

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the surgeons from Department of Orthopedics of West China Hospital. All authors have read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China

    Wenyu Jiang, Hong Xu, Qiang Huang, Zongke Zhou & Fuxing Pei

  2. Department of Orthopaedics, The Third People’s Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China

    Xing Wang

  3. West China Department of Clinical Medicine, Sichuan University, Chengdu, China

    Zhuangzhuang Jia & Chengzhi Liao

Authors
  1. Wenyu Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhuangzhuang Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chengzhi Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qiang Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zongke Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fuxing Pei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qiang Huang.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of West China Hospital of Sichuan University (Date May 11, 2021/No.2022–748).

Consent to participate

Written informed consent from participants was not required because the study was retrospective and analyzed anonymized data with no risk to the patients.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Wenyu Jiang, Hong Xu, and Xing Wang are co-first authors; these three authors contributed to this article equally.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, W., Xu, H., Wang, X. et al. More complications and higher transfusion rate in patients with rheumatoid arthritis than osteoarthritis undergoing total hip arthroplasty. International Orthopaedics (SICOT) 47, 1189–1196 (2023). https://doi.org/10.1007/s00264-023-05728-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05728-7

Keywords

Search

Navigation