Outcome of prosthetic joint infection in patients with rheumatoid arthritis: The impact of medical and surgical therapy in 200 episodes

Elie F. Berbari, Douglas R. Osmon, M. C T Duffy, R. M W Harmssen, Jayawant Mandrekar, Arlen D. Hanssen, James M. Steckelberg

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Abstract

Background. Prosthetic joint infection in patients with rheumatoid arthritis is a serious complication of total joint arthroplasty. Little information is available on the outcome of medical and surgical treatments of prosthetic joint infection in patients with rheumatoid arthritis. Methods. We conducted a retrospective analysis of all patients with rheumatoid arthritis and a total hip or total knee arthroplasty infection evaluated at Mayo Clinic (Rochester, MN) between 1 January 1969 and 31 December 1995. Results. A total of 200 first episodes of prosthetic joint infection in 160 patients with rheumatoid arthritis were diagnosed during the study period. Thirty-seven percent of prosthetic joint infection episodes were due to Staphylococcus aureus. Of these episodes, 23% and 19% were treated with debridement and retention of components and 2-stage exchange, respectively. The type of surgical procedure was the only analyzed clinical variable that was associated with treatment failure (P < .001). Rates of 5-year survival free of treatment failure for patients with prosthetic joint infection episodes treated with debridement and retention of components, 2-stage exchange, and resection arthroplasty were 32% (95% confidence interval [CI], 21%-49%), 79% (95% CI, 66%-93%), and 61% (95% CI, 49%-74%), respectively. Conclusions. S. aureus is the most common pathogen among patients with rheumatoid arthritis with prosthetic joint infection. Two-stage exchange was used in only 19% of the prosthetic joint infection episodes among patients with rheumatoid arthritis during the study period, but it was associated with the best outcome. The variable most strongly associated with the outcome was the type of surgical procedure.

Original languageEnglish (US)
Pages (from-to)216-223
Number of pages8
JournalClinical Infectious Diseases
Volume42
Issue number2
DOIs
StatePublished - Jan 15 2006

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Rheumatoid Arthritis
Joints
Infection
Debridement
Confidence Intervals
Therapeutics
Treatment Failure
Arthroplasty
Staphylococcus aureus
Knee Replacement Arthroplasties
Hip
Survival

ASJC Scopus subject areas

  • Immunology

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Outcome of prosthetic joint infection in patients with rheumatoid arthritis : The impact of medical and surgical therapy in 200 episodes. / Berbari, Elie F.; Osmon, Douglas R.; Duffy, M. C T; Harmssen, R. M W; Mandrekar, Jayawant; Hanssen, Arlen D.; Steckelberg, James M.

In: Clinical Infectious Diseases, Vol. 42, No. 2, 15.01.2006, p. 216-223.

Research output: Contribution to journalArticle

Berbari, Elie F. ; Osmon, Douglas R. ; Duffy, M. C T ; Harmssen, R. M W ; Mandrekar, Jayawant ; Hanssen, Arlen D. ; Steckelberg, James M. / Outcome of prosthetic joint infection in patients with rheumatoid arthritis : The impact of medical and surgical therapy in 200 episodes. In: Clinical Infectious Diseases. 2006 ; Vol. 42, No. 2. pp. 216-223.
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abstract = "Background. Prosthetic joint infection in patients with rheumatoid arthritis is a serious complication of total joint arthroplasty. Little information is available on the outcome of medical and surgical treatments of prosthetic joint infection in patients with rheumatoid arthritis. Methods. We conducted a retrospective analysis of all patients with rheumatoid arthritis and a total hip or total knee arthroplasty infection evaluated at Mayo Clinic (Rochester, MN) between 1 January 1969 and 31 December 1995. Results. A total of 200 first episodes of prosthetic joint infection in 160 patients with rheumatoid arthritis were diagnosed during the study period. Thirty-seven percent of prosthetic joint infection episodes were due to Staphylococcus aureus. Of these episodes, 23{\%} and 19{\%} were treated with debridement and retention of components and 2-stage exchange, respectively. The type of surgical procedure was the only analyzed clinical variable that was associated with treatment failure (P < .001). Rates of 5-year survival free of treatment failure for patients with prosthetic joint infection episodes treated with debridement and retention of components, 2-stage exchange, and resection arthroplasty were 32{\%} (95{\%} confidence interval [CI], 21{\%}-49{\%}), 79{\%} (95{\%} CI, 66{\%}-93{\%}), and 61{\%} (95{\%} CI, 49{\%}-74{\%}), respectively. Conclusions. S. aureus is the most common pathogen among patients with rheumatoid arthritis with prosthetic joint infection. Two-stage exchange was used in only 19{\%} of the prosthetic joint infection episodes among patients with rheumatoid arthritis during the study period, but it was associated with the best outcome. The variable most strongly associated with the outcome was the type of surgical procedure.",
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