LOCAL COMPLICATIONS OF HIP AND KNEE JOINT REPLACEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS
https://doi.org/10.14412/1995-4484-2017-549-554
Abstract
Total joint replacement (TJR) in the presence of severe joint degradation and arthralgias in patients with rheumatic diseases (RDs) is one of the effective ways to improve the functional status of patients and their quality of life. In recent years, there has been an increase in the number of such knee and hip replacements worldwide. Despite advances in medicine in the 21st century, up to 5% of TJRs culminate in early complications, in which there are irreversible joint changes that cause joint functional loss and persistent pain and, in 2–3% of cases, require early re-revision surgery.
Subjects and methods. The investigation included 2142 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent knee or hip joint replacement (KJR or HJR) at the V.A. Nasonova Research Institute of Rheumatology during the period 1998 to 2016: HJR in 1177 patients and KJR in 965. The patients with RA had 467 HJRs and 651 KJRs (a total of 1118 operations). A comparison group consisted of patients with OA who underwent
710 HJRs and 314 KJRs (a total of 1024 operations). Postoperative surgical complications, such as superficial or deep suppuration, joint dislocation, periprosthetic fractures, sciatic and/or peroneal neuropathies, aseptic instability of endoprosthesis components, and complications of wound and ligamentous apparatus, were considered within 2 years after surgery
Results and discussion. Overall, the frequency of local complications after HJR and KJR was comparable and amounted to 7.22 and 7.25%, respectively (p=0.83), but their pattern greatly differed: there were a larger number of periprosthetic fractures after HJR than after KJR (3.48% and 0.93%; p <0.001). After KJR as compared to HJR, there were a greater number of infectious complications (1.66 and 0.27%; p <0.001) and a longer postoperative wound healing (1.87 and 0.42%; p <0.001). Comparison of the frequency of local complications revealed that there is a significant increase in patients with RA (29%) compared with those with OA (5.21%; p=0.001). The pattern of local complications was characterized by significant differences only in the frequency of periprosthetic fractures (p=0.028) and poor postoperative wound healing (p=0.019), which was higher than that in patients with RA. There was no statistically significant difference in the frequency of local complications after KJR in patients with RA and those with OA. Thus, surgical treatment of patients with RA requires a special approach that includes the competent perioperative medical management of a patient and the careful handling of the bone and surrounding tissues during surgery.
About the Authors
A. E. KhramovRussian Federation
Russia 34A, Kashirskoe Shosse, Moscow 115522
M. A. Makarov
Russian Federation
Russia 34A, Kashirskoe Shosse, Moscow 115522
S. A. Makarov
Russian Federation
Russia 34A, Kashirskoe Shosse, Moscow 115522
E. I. Byalik
Russian Federation
Russia 34A, Kashirskoe Shosse, Moscow 115522
V. N. Amirdzhanova
Russian Federation
Russia 34A, Kashirskoe Shosse, Moscow 115522
V. P. Pavlov
Russian Federation
Russia 34A, Kashirskoe Shosse, Moscow 115522
A. V. Rybnikov
Russian Federation
Russia 34A, Kashirskoe Shosse, Moscow 115522
References
1. NIH consensus conference: Total hip replacement. NIH Consensus Development Panel on Total Hip Replacement. [Consensus Development Conference Consensus Development Conference, NIH Review]. JAMA. 1995 Jun 28;273(24):1950-6.
2. Jones CA, Beaupre LA, Johnston DWC, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. [Review]. Rheum Dis Clin N Am. 2007 Feb;33(1):71- 86. doi: 10.1016/j.rdc.2006.12.008
3. Merx H, Dreinhofer K, Schrader P, et al. International variation in hip replacement rates. [Research Support, Non-U.S. Gov't Review]. Ann Rheum Dis. 2003 Mar;62(3):222-6. doi: 10.1136/ard.62.3.222
4. Ravi B, Croxford R, Reichmann W, et al. The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007. Best Pract Res Clin Rheumatol. 2012;26(5):637-47. doi: 10.1016/j.berh.2012.07.014
5. Santaguida PL, Hawker GA, Hudak PL, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. [Research Support, Non-U.S. Gov't Review]. Can J Surg. 2008 Dec;51(6):428-36.
6. Heck DA, Melfi CA, Mamlin LA, et al. Revision rates after knee replacement in the United States. [Research Support, U.S. Gov't, P.H.S.]. Med Care. 1998 May;36(5):661-9. doi: 10.1097/00005650-199805000-00006
7. Papakostidou I, Dailiana ZH, Liaropoulos L, et al. Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord. 2012 Jun 29;13:116. doi: 10.1186/1471-2474-13-116
8. Линник СА, Ромашов ПП, Новоселов КА и др. Раннее двухэтапное ревизионное эндопротезирование тазобедренного и коленного суставов после глубокого нагноения. Травматология и ортопедия. 2009;(3):151-5 [Linnik SA, Romashov PP, Novoselov KA, et al. Early two-stage revision of hip and knee joint endoprosthetics after deep suppuration. Travmatologiya i Ortopediya. 2009;(3):151-5 (In Russ.)].
9. Bauer T, Parvizi J, Kobayashi N, Krebs V. Diagnosis of Periprosthetic Infection. J Bone Jt. Surg. 2006;4:869-80.
10. Giulieri SG, Graber P, Ochsner PE, Zimmerli W. Management of infection associated with total hip arthroplasty according to a treatment algorithm. [Erratum appears in Infection. 2004 Oct;32(5):309]. Infection. 2004 Aug;32(4):222-8. doi: 10.1007/s15010-004-4020-1
11. Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.
12. [Comparative Study]. Infect Control Hosp Epidemiol. 1992 Oct;13(10):606-8. doi: 10.1017/S0195941700015241
13. Moureau N. Vascular safety: it's all about PICCs. [Review]. Nurs Manag. 2006 May;37(5):22-7; quiz 50. doi: 10.1097/00006247-200605000-00007
14. Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. [Research Support, Non-U.S. Gov't Review]. J Bone Joint Surg Br. 2006 Feb;88(2):149-55. doi: 10.1302/0301-620X.88B2.17058
15. Clyburn TA, Cui Q. Antibiotic laden cement: Current state of the art. AAOS Now. 2013;7(6) (Available online: http://www.aaos.org/news/bulletin/may07/clinical7.asp).
16. De Palma L, Procaccini R, Soccetti A, Marinelli M. Hospital cost of treating early dislocation following hip arthroplasty. Hip International. 2012 Jan-Feb;22(1):62-7. doi: 10.5301/HIP.2012.9059
17. Ключевский ВВ, Даниляк ВВ, Белов МВ и др. Вывихи после тотального замещения тазобедренного сустава: факторы риска, способы лечения. Травматология и ортопедия. 2009;(3):136-8 [Klyuchevskii VV, Danilyak VV, Belov MV, et al. Dislocation after total hip replacement: risk factors, treatment options. Travmatologiya i Ortopediya. 2009; (3):136-8 (In Russ.)].
18. Kwon MS, Kuskowski M, Mulhall KJ, et al. Does surgical approach affect total hip arthroplasty dislocation rates? [Comparative Study Meta-Analysis Research Support, Non- U.S. Gov't Review]. Clin Orthop. 2006 Jun;447:34-8. doi: 10.1097/01.blo.0000218746.84494.df
19. Richards CJ, Garbuz DS, Masri BA, Duncan CP. Vancouver type B3 periprosthetic fractures: evaluation and treatment. Instruct Course Lect. 2009;58:177-81.
20. Волокитина ЕА, Зайцева ОП, Колотыгин ДА, Вишняков АА. Локальные интраоперационные и ранние послеоперационные осложнения эндопротезирования тазобедренного сустава. Гений ортопедии. 2009;(3):71-7 [Volokitina EA, Zaitseva OP, Kolotygin DA, Vishnyakov AA. Local intraoperative and early postoperative complications of hip arthroplasty. Genii Ortopedii. 2009;(3):71-7 (In Russ.)].
21. Mounasamy V. Acute sciatic neuritis following total hip arthroplasty: a case report. Arch Orthop Trauma Surg. 2008;128:25-8. doi: 10.1007/s00402-006-0261-z
22. Руцкий АВ, Маслов АП. К проблеме эндопротезирования крупных суставов. Медицинские новости. 2005;(12):73-6 [Rutskii AV, Maslov AP. To the problem of arthroplasty of large joints. Meditsinskie Novosti. 2005;(12):73-6 (In Russ.)].
23. Pellicci PM, Wilson PD Jr, Sledge CB, et al. Long-term results of revision total hip replacement: a follow-up report. J Bone Joint Surg. 1985;67-A:513-6. doi: 10.2106/00004623-198567040-00002
24. Raikin S.M. Total ankle arthroplasty. Orthopedics. 2010 Dec;33(12):890-1. doi: 10.3928/01477447-20101021-18
25. Parker DA, Dunbar MJ, Rorabeck CH. Extensor mechanism failure associated with total knee arthroplasty: prevention and management. J Am Acad Orthop Surg. 2003;11(4):238-47. doi: 10.5435/00124635-200307000-00003
26. Burns AWR, Bourne RB, Chesworth BM, et al. Cost effectiveness of revision total knee arthroplasty. [Comparative Study]. Clin Orthop. 2006 May;446:29-33. doi: 10.1097/01.blo.0000214420.14088.76
27. Bozic KJ, Katz P, Cisternas M, et al. Hospital resource utilization for primary and revision total hip arthroplasty. [Comparative Study Research Support, Non-U.S. Gov't]. J Bone Joint Surg – Amer Vol. 2005 Mar;87(3):570-6. doi: 10.2106/00004623-200503000-00014
28. Bongartz T, Halligan CS, Osmon DR, et al. Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. [Comparative Study Research Support, N.I.H., Extramural Research Support, Non- U.S. Gov't]. Arthritis Rheum. 2008 Dec 15;59(12):1713-20. doi: 10.1002/art.24060
29. Schrama JC, Espehaug B, Hallan G, et al. 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. [Comparative Study]. Arthritis Care Res (Hoboken). 2010 Apr;62(4):473-9. doi: 10.1002/acr.20036
30. Boursinos LA, Karachalios T, Poultsides L, Malizos KN. Do steroids, conventional non- steroidal anti-inflammatory drugs and selective Cox-2 inhibitors adversely affect fracture healing? [Review]. J Musculoskelet Neur Interact. 2009 Jan-Mar;9(1):44-52.
31. Gravallese EM. Bone destruction in arthritis. [Review]. Ann Rheum Dis. 2002 Nov;61 Suppl 2:ii84-6. doi: 10.1136/ard.61.suppl_2.ii84
32. Mikuls TR, Saag KG, Curtis J, et al. Prevalence of osteoporosis and osteopenia among African Americans with early rheumatoid arthritis: the impact of ethnic-specific normative data. [Multicenter Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, P.H.S.]. J Nat Med Assoc. 2005 Aug;97(8):1155-60.
33. Goldring SR. Periarticular bone changes in rheumatoid arthritis: pathophysiological implications and clinical utility. [Erratum appears in Ann Rheum Dis. 2009 Jun;68(6):1080]. [Comment Editorial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. Ann Rheum Dis. 2009 Mar;68(3):297- 9. doi: 10.1136/ard.2008.099408
34. Слободской АБ, Осинцев ЕЮ, Лежнев АГ. Осложнения эндопротезирования тазобедренного сустава. Вестник травматологии и ортопедии. 2011;(3):59-63 [Slobodskoi AB, Osintsev EYu, Lezhnev AG. Complications of hip arthroplasty. Vestnik Travmatologii i Ortopedii. 2011;(3):59-63 (In Russ.)].
35. Yao X, Li H, Leng SX. Inflammation and immune system alterations in frailty. [Research Support, N.I.H., Extramural]. Clin Geriatr Med. 2011 Feb;27(1):79-87. doi: 10.1016/j.cger.2010.08.002
36. Buckley LM, Leib ES, Cartularo KS, et al. Effects of low dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis. Medicial College of Virginia/Virginia Commonwealth University, Richmond 23298, USA. J Rheumatol. 1995;22(6):1055-9.
37. Khatod M, Barber T, Paxton E, et al. An analysis of the risk of hip dislocation with a contemporary total joint registry. [Comparative Study Research Support, Non-U.S. Gov't]. Clin Orthop. 2006 Jun;447:19-23. doi: 10.1097/01.blo.0000218752.22613.78
38. Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, et al. Redefining overweight and obesity in rheumatoid arthritis patients. [Research Support, Non-U.S. Gov't]. Ann Rheum Dis. 2007 Oct;66(10):1316-21. doi: 10.1136/ard.2006.060319
39. Conroy JL, Whitehouse SL, Graves SE, et al. Risk factors for revision for early dislocation in total hip arthroplasty. J Arthroplasty. 2008 Sep;23(6):867-72. doi: 10.1016/j.arth.2007.07.009
40. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. [Review]. Arthritis Care Res (Hoboken). 2012 May;64(5):625-39.
Review
For citations:
Khramov A.E., Makarov M.A., Makarov S.A., Byalik E.I., Amirdzhanova V.N., Pavlov V.P., Rybnikov A.V. LOCAL COMPLICATIONS OF HIP AND KNEE JOINT REPLACEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS. Rheumatology Science and Practice. 2017;55(5):549-554. (In Russ.) https://doi.org/10.14412/1995-4484-2017-549-554