Complications of total knee arthroplasty and the development of late deep infection in patients with rheumatoid arthritis

Year 2023, Volume: 6 Issue: 2, 540 - 545, 27.03.2023

Alikemal Yazıcı

https://doi.org/10.32322/jhsm.1244085

Abstract

Aim: This study aimed to assess complications and the presence of late deep infection in patients with rheumatoid arthritis (RA) who underwent primary and revision total knee arthroplasty (TKA).
Materıial and Method: Between June 1997 and October 2022, cemented TKA that cut the posterior cruciate ligament (PCL) was applied to 50 knees of 34 patients with RA, and posterior-stabilized (PS) revision TKA was applied to 7 knees of 5 patients. All the patients enclosed in this study were adults diagnosed with RA by a rheumatology or physical therapy physician according to the RA diagnostic criteria recommended by the American College of Rheumatology in 1987. The diagnosis of infection was based on the Periprosthetic Infection Diagnostic Criteria of the 2018 International Periprosthetic Joint Infections Consensus Meeting.
Results: Complications were found in 9 (18%) of the 50 knees who underwent primary TKA. Postoperative serous discharge was observed in 3 (6%) knees, serous discharge and late partial rupture of the quadriceps tendon in 1 (2%), early deep infection in 1 (2%), late deep infection in 3 (6%), and hematoma in 1 (2%). Revision surgery was performed on 3 (6%) knees due to infection and on 4 (8%) knees due to aseptic loosening. Complications developed in 2 of these knees who underwent revision TKA, 1 (14.3%) knee with periprosthetic fracture in the femur in the first postoperative year, and 1 (14.3%) knee with early deep infection. Deep vein thrombosis (DVT), pulmonary emboli (PE) and heterotopic ossification (HO) were not observed in any patient.
Conclusion: In patients with rheumatoid arthritis, total knee arthroplasty increased chronic late deep infection and the associated need for revision surgery, and decreased the rates of DVT, PE, HO.

Keywords

Rheumatoid arthritis, total knee arthroplasty, complications

References

• Lee JK, Choi CH. Total knee arthroplasty in rheumatoid arthritis. Knee Surg Relat Res 2012; 24: 1-6.
• Radu AF, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells 2021; 10: 2857.
• Lin YJ, Anzaghe M, Schülke S. Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells 2020; 9: 880.
• Roche CJ, Eyes BE, Whitehouse GH. The rheumatoid cervical spine: signs of instability on plain cervical radiographs. Clin Radiol 2002; 57: 241–9.
• Singh JA, Lewallen DG. Better functional and similar pain outcomes in osteoarthritis compared with rheumatoid arthritis after primary total knee arthroplasty: a cohort study. Arthritis Care Res 2013; 65: 1936–41.
• Bernatsky S, Hudson M, Suissa S. Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford) 2007; 46: 1157–60.
• Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006; 295: 2275-85.
• Stundner O, Danninger T, Chiu YL, et al. Rheumatoid arthritis vs osteoarthritis in patients receiving total knee arthroplasty: perioperative outcomes. J Arthroplasty 2014; 29: 308-13.
• Berbari EF, Osmon DR, Duffy MC et al. Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis 2006; 142: 216–23.
• Saleh KJ, Kurdi AJ, El-Othmani MM, et al. Perioperative treatment of patients with rheumatoid arthritis. J Am Acad Orthop Surg 2015; 23: 38−48.
• da Cunha BM, de Oliveira SB, Santos-Neto L. Incidence of infectious complications in hip and knee arthroplasties in rheumatoid arthritis and osteoarthritis patients. Rev Bras Reumatol 2011; 51: 609−15.
• Barnard AR, Regan M, Burke FD, Chung KC, Wilgis EF. Wound healing with medications for rheumatoid arthritis in hand surgery. ISRN Rheumatol 2012; 5: 251962.
• Bacani AK, Gabriel SE, Crowson CS, Heit JA, Matteson EL. Noncardiac vascular disease in rheumatoid arthritis: increase in venous thromboembolic events? Arthritis Rheum 2012; 64: 53–61.
• Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Asociation 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315–24.
• Proceedings of the International Consensus Meeting on Prosthetic Joint Infection. The Journal of Arthroplasty ICM Philly October 29, 2018.
• Heo SM, Harris I, Naylor J, Lewin AM. Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord 2020; 21: 602.
• Yohe N, Funk A, Ciminero M, Erez O, Saleh A. Complications and readmissions after total knee replacement in octogenarians and nonagenarians. Geriatr Orthop Surg Rehabil 2018; 9: 2151459318804113.
• Garcia RM, Hardy BT, Kraay MJ, Goldberg VM. Revision total knee arthroplasty for aseptic and septic causes in patients with rheumatoid arthritis. Clin Orthop Relat Res 2010; 468: 82-9.
• Chesney D, Sales J, Elton R, Brenkel IJ. Infection after knee arthroplasty a prospective study of 1509 cases. J Arthroplasty 2008; 23: 355-9.
• Rodriguez JA, Saddler S, Edelman S, Ranawat CS. Long-term results of total knee arthroplasty in class 3 and 4 rheumatoid arthritis. J Arthroplasty 1996; 11: 141–5.
• Mortazavi SM, Schwartzenberger J, Austin MS, Purtill JJ, Parvizi J. Revision total knee arthroplasty infection: incidence and predictors. Clin Orthop Relat Res 2010; 468: 2052-9.
• Lee DK, Kim HJ, Cho IY, Lee DH. Infection and revision rates following primary total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25: 3800-7.
• Alexander B, Watson JB, Chandler K, et al. Impact of resident involvement on complication rates in revision total knee arthroplasty. J Taibah Univ Med Sci 2022; 17: 969-75.
• Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 2001; 60: 214–7.
• Konan S, Sandiford N, Unno F, Masri BS, Garbuz DS, Duncan CP. Periprosthetic fractures associated with total knee arthroplasty: an update. Bone Joint J 2016; 98-B: 1489-96.
• Zainul-Abidin S, Lim B, Bin-Abd-Razak HR, et al. Periprosthetic fractures after total knee arthroplasty: the influence of pre-operative mechanical factors versus intraoperative factors. Malays Orthop J 2019; 13: 28-34.
• Lombardi AV, Jr, Berend KR, Adams JB. Why knee replacements fail in 2013: Patient, surgeon or implant. Bone Joint J 2014; 96: 101–4.
• da Silva E, Doran MF, Crowson CS, O'Fallon WM, Matteson EL. Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long-term, population-based assessment. Arthritis Care Res 2003; 49: 216–220.
• Lee JK, Kee YM, Chung HK, Choi CH. Long-term results of cruciate-retaining total knee replacement in patients with rheumatoid arthritis: a minimum 15-year review. Can J Surg 2015; 58: 193-7.
• Türk Toraks Derneği Pulmoner Tromboemboli tanı ve tedavi uzlaşı raporu 2021.
• Niki Y, Matsumoto H, Hakozaki A, Mochizuki T, Momohara S. Rheumatoid arthritis: a risk factor for deep venous thrombosis after total knee arthroplasty? Comparative study with osteoarthritis. J Orthop Sci 2010; 15: 57–63.
• Kim SC, Schneeweiss S, Liu J, Solomon DH. Risk of venous thromboembolism in patients with rheumatoid arthritis. Arthritis Care Res 2013; 65: 1600–7.
• Solomon DH, Kremer JF, Curtis JR et al. Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity. Ann Rheum Dis 2010; 69: 1920–5.
• Dobbs RE, Hanssen AD, Lewallen DG, Pagnano MW. Quadriceps tendon rupture after total knee arthroplasty. Prevalence, complications, and outcomes. J Bone Joint Surg Am 2005; 87: 37-45.
• Park SS, Kubiak EN, Wasserman B, et al. Management of extensor mechanism disruptions occurring after total knee arthroplasty. Am J Orthop 2005; 34: 365-72.
• Liu N, Luo S, Hang C, et al. Changes in coagulation functions and hemorheological parameters may predict hematoma formation after total knee arthroplasty. J Orthop Surg Res 2016; 11: 35.
• Gkiatas I, Xiang W, Karasavvidis T, et al. Relatively low rate of heterotopic ossification following primary total knee arthroplasty: a systematic review and meta-analysis. J Am Acad Orthop Surg Glob Res Rev 2021; 5: e21.00096.
• Rader CP, Barthel T, Haase M, Scheidler M, Eulert J. Heterotopic ossification after total knee arthroplasty. 54/615 cases after 1-6 years’ follow-up. Acta Orthop Scand 1997; 68: 46-50.