Moderating effects of immunosuppressive medications and risk factors for post-operative joint infection following total joint arthroplasty in patients with rheumatoid arthritis or osteoarthritis.

Salt E, Wiggins AT, Rayens MK, Morris BJ, Mannino D, Hoellein A, Donegan RP, Crofford LJ
Semin Arthritis Rheum. 2017 46 (4): 423-429

PMID: 27692433 · PMCID: PMC5325817 · DOI:10.1016/j.semarthrit.2016.08.011

OBJECTIVE - Inconclusive findings about infection risks, importantly the use of immunosuppressive medications in patients who have undergone large-joint total joint arthroplasty, challenge efforts to provide evidence-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a post-operative infection in patients undergoing TJA of a large joint (total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty) by identifying clinical and demographic factors, including the use of high-risk medications (i.e., prednisone and immunosuppressive medications) and diagnoses [i.e., rheumatoid arthritis (RA), osteoarthritis (OA), gout, obesity, and diabetes mellitus] that are linked to infection status, controlling for length of follow-up.

METHODS - A retrospective, case-control study (N = 2212) using de-identified patient health claims information from a commercially insured, U.S. dataset representing 15 million patients annually (from January 1, 2007 to December 31, 2009) was conducted. Descriptive statistics, t-test, chi-square test, Fisher's exact test, and multivariate logistic regression were used.

RESULTS - Male gender (OR = 1.42, p < 0.001), diagnosis of RA (OR = 1.47, p = 0.031), diabetes mellitus (OR = 1.38, p = 0.001), obesity (OR = 1.66, p < 0.001) or gout (OR = 1.95, p = 0.001), and a prescription for prednisone (OR = 1.59, p < 0.001) predicted a post-operative infection following total joint arthroplasty. Persons with post-operative joint infections were significantly more likely to be prescribed allopurinol (p = 0.002) and colchicine (p = 0.006); no significant difference was found for the use of specific disease-modifying anti-rheumatic drugs and TNF-α inhibitors.

CONCLUSION - High-risk, post-operative joint infection groups were identified allowing for precautionary clinical measures to be taken.

Copyright © 2017 Elsevier Inc. All rights reserved.

MeSH Terms (35)

Aged Allopurinol Arthritis, Rheumatoid Arthroplasty, Replacement Arthroplasty, Replacement, Hip Arthroplasty, Replacement, Knee Arthroplasty, Replacement, Shoulder Case-Control Studies Comorbidity Diabetes Mellitus Female Glucocorticoids Gout Gout Suppressants HIV Infections Humans Immunologic Deficiency Syndromes Immunosuppressive Agents Logistic Models Lupus Erythematosus, Systemic Male Middle Aged Multivariate Analysis Neoplasms Obesity Osteoarthritis Osteoarthritis, Hip Osteoarthritis, Knee Prednisone Prosthesis-Related Infections Retrospective Studies Risk Factors Sex Factors Shoulder Joint Surgical Wound Infection

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