Post-operative infection in total knee arthroplasty in steroid dependent rheumatoid arthritis (original) (raw)
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Mid-Term Results of Total Knee Replacement in Patients with Rheumatoid Arthritis
2015
Knee is among the most commonly affected joints in rheumatoid arthritis, which is the most common form of inflammatory arthritis, affecting 1% of men and 3% of women.Total Knee Arthroplasty in the rheumatoid patient presents unique challenges, such as the systemic nature, poor bone quality as a result of prolonged steroid use soft-tissue deformities, valgus fixed deformities and flexion contractures and the disease process itself. The purpose of our study is to look out for clinical outcomes in midterm and long term follow up of rheumatoid patients operated for total knee replacement.This is a retrospective study of 100 consecutive primary TKR in 61 patients with rheumatoid arthritis. A total of 61 patients, (49 females, 12 males) with a mean age of 58.4 years underwent the surgery. All-Poly, high flexion, LCCK and metal back varieties were used in such patients.The mean duration of follow up of patient was 3.7years. 97% of patients showed improvement in their preoperative pain. The mean range of movement improved from 78.3 to 109.27. 70 percent of patients achieved a ROM of 100 degrees and above. Fixed flexion deformity, extensor lag, and mediolateral instability almost disappeared. The mean knee score improved from 35.22 to 83.01. Statistically significant improvement occur in Postoperative limb functions as shown by increase in WOMAC score from 52.01 to 81 and Knee society functional score improved from 36.4 to 75.1. Late infection was the most common complication, with an overall satisfactory outcome of the study.
Functional Outcome of Total Knee Replacement in Patients with Rheumatoid Arthritis
Journal of Pakistan Orthopaedic Association, 2016
Objective: To evaluate the functional outcome of Rheumatoid Arthritis (RA) undergoing primary total knee arthroplasty (TKA). Methods: Data was analyzed from Pakistan National Joint Registry (PNJR) from April 2014 to April 2015 to assess functional outcome of all patients who underwent TKA by a single surgeon and had a diagnosis of rheumatoid arthritis using Knee Society Scores (KSS) preoperatively and postoperatively at 3 months, 6 month and 1 year. Result: Out of 39 patients 31 were female and 8 were male with mean age of 55.58±8.35 and mean Body Mass Index of 29.21±4.80.Within 39 patients, 22 patients had left sided TKA and 17 patients had right sided TKA. The mean average of Knee and Function score was 95.38±1.23 and 94.17±9.87 respectively after 1 year follow up. Average knee range of motion had increased from 98.52±2.46 degrees preoperatively to 109.37±3.61 degrees postoperatively. Conclusion: Total knee arthoplasty in patients with rheumatoid arthritis is a good surgical option with about 71.8 percent of people having excellent functional outcome according to knee society scoring system.
Total Knee Arthroplasty in Patients With Rheumatoid Arthritis
Clinical Orthopaedics and Related Research, 1999
Total knee arthroplasty in patients with rheumatoid arthritis presents several unique challenges. Patients with rheumatoid arthritis often have additional medical, anesthetic, and global musculoskeletal problems that are not present in the patient with osteoarthritis. In terms of the knee, these patients usually have osteopenia and may present with an array of bone and soft tissue deformities, each of which can impact the initial success and long term durability of a total knee replacement. Despite these potential difficulties, the early and long term results of total knee arthroplasty in patients with rheumatoid arthritis have proven to be excellent. Knee involvement is uncommon during the early stages of rheumatoid arthritis. However, one or both knees ultimately will be affected in approximately 90% of individuals with chronic rheumatoid arthritis. In 65% to 70% of instances, both knees are involved.6 The early stages of rheumatic knee disease consist of synovitis that progresses to articular cartilage destruction, and in some cases, leads to bone loss and ligamentous incompetency with either laxity or contracture and fixed deformity.
Thirty-day complications in rheumatoid patients following total knee arthroplasty
Clinical Rheumatology, 2015
Although total knee arthroplasty (TKA) is highly successful for patients with end-stage rheumatoid arthritis (RA), the risks and complications associated with surgery in this cohort are less defined. The objectives of our study were to analyze the demographic and perioperative factors of RA patients that may affect post-TKA outcomes, as well as to assess the 30-day complication rates compared to osteoarthritis patients. We retrospectively evaluated the National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2012 to assess all patients who underwent a primary TKA and had a diagnosis of rheumatoid arthritis (n=141) or primary knee osteoarthritis (n=7125). We evaluated and compared the demographic factors, social factors, preoperative factors, operative factors, and postoperative complications. The RA cohort had a lower mean age and body mass index than patients in the OA group. There was also a significantly higher incidence of women and Hispanics in the RA cohort. There was a lower incidence of diabetes and hypertension requiring medication in the rheumatoid cohort, but also a higher incidence of bleeding disorders. The RA cohort had an increased proportion of patients requiring blood transfusions and had a longer mean length of stay.
The Journal of rheumatology, 2015
More adverse events (AE) are reported after total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA) than for patients with osteoarthritis (OA). This study evaluates 6-month postoperative AE in a high-volume center in a contemporary RA cohort. Patients with RA in an institutional registry (2007-2010) were studied. AE were identified by self-report and review of office and hospital charts. Subjects with RA were matched to 2 with OA by age, sex, and procedure. RA-specific surgical volume was determined. Baseline characteristics and AE were compared and analyzed. There were 159 RA TKA and 318 OA. Of the patients with RA, 88.0% were women, 24.5% received corticosteroids, 41.5% received biologics, and 67% received nonbiologic disease-modifying antirheumatic drugs (DMARD). There was no difference in comorbidities. RA-specific surgical volume was high; 64% of cases were performed by surgeons with ≥ 20 RA cases during the study period. Patients with RA had worse baseline pa...
Surgical Update: International Journal of Surgery and Orthopedics, 2019
Introduction: Total knee arthroplasty (TKA) is a surgical procedure that provides pain relief and restores function for patients suffering from debilitating arthritis. Despite the overall success of the procedure, periprosthetic joint infection (PJI) is a rare but devastating complication andfound to be a major cause of TKA failure.An infected implant often requires removal, prolonged immobilization and antibiotic treatment and multistage surgery. Hence, prevention of infections in intraoperative and postoperative stage is of paramount importance. Material and Method: We have conducted a retrospective study in SreeSudheendra Medical Mission hospital, Ernakulum, Kerala. We collected the data from April 2014 to March 2018. In this duration we have found 89 cases of rheumatoid arthritis underwent TKA in 148 knees. We have collected and analysed demographic data and information regarding risk factors [like ESR, H/O Diabeties, steroid intake, blood transfusion, preop deformity, preop DMARDs, intraop soft tissue manipulation/finding, Albumin Globulin ratio (A/G)] associate with infection. Postoperatively we have followed our patient for the minimum period of 9 months period to 4 years. Result: We identified DMARDs (esp.methotraxate) and intraoperative manipulation like bone grafting, extra soft tissue release, Z-plasty of tendon as a risk factor for superficial periprosthetic infection (P value <0.05). Diabetes, use of Steroid, Age, Anemia, Blood Transfusion, B/L surgery are not a risk factor for infection (P value > 0.05). Conclusion: These results guide our understanding of the relationship between infections and TKA in RA patient, and may help to prospectively identifying high-risk patients, facilitating extra vigilance and implementation of preventive strategies in such patients.
The Journal of rheumatology, 2016
Although new treatments for rheumatoid arthritis (RA) are extremely effective in preventing disease progression, rates of total knee replacement (TKR) continue to rise. The ongoing need for TKR is problematic, especially as functional outcomes in patients with RA have been reported to be worse than in patients with osteoarthritis (OA). The purpose of this study is to assess pain, function, and quality of life 2 years after TKR in contemporary patients with RA compared with patients with OA. Primary TKR cases enrolled between May 1, 2007 and July 1, 2010 in a single institution TKR registry were eligible for this study. Validated RA cases were compared with OA at baseline and at 2 years. We identified 4456 eligible TKR, including 136 RA. Compared with OA, RA TKR had significantly worse preoperative Western Ontario and McMaster Universities Osteoarthritis Index pain (55.9 vs 46.6, p < 0.0001) and function (58.7 vs 47.3, p < 0.0001); however, there were no differences at 2 years....
Total Knee Arthroplasty Considerations in Rheumatoid Arthritis
Autoimmune Diseases, 2013
The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success.
The Journal of Arthroplasty, 2014
There is a paucity of data available on perioperative outcomes of patients undergoing total knee arthroplasty (TKA) for rheumatoid arthritis (RA). We determined differences in demographics and risk for perioperative adverse events between patients suffering from osteoarthritis (OA) versus RA using a population-based approach. Of 351,103 entries for patients who underwent TKA, 3.4% had a diagnosis of RA. RA patients were on average younger [RA: 64.3 years vs OA: 66.6 years; p<0.001] and more likely female [RA: 79.2% vs OA: 63.2%; P<0. 001]. The unadjusted rates of mortality and most major perioperative adverse events were similar in both groups, with the exception of infection [RA: 4.5% vs. OA: 3.8%; P<0.001]. RA was not associated with increased adjusted odds for combined adverse events.