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Abbreviations ASA: American Society of Anesthesiologists; BIRLS: Beneficiary Identification of Records Locator System; CHF: Congestive heart failure; COPD: Chronic obstructive pulmonary disease; CPR: Cardiopulmonary resuscitation; CPT: Current procedural terminology; CV: Cardiovascular; CVA: Cerebrovascular accident; DMARD: Disease-modifying antirheumatic drug; GCS: Glucocorticosteroid; HR: Hazard ratio; ICD9: International Statistical Classification of Disease and Related Health Problems, Ninth Revision; OA: Osteoarthritis; OR: Odds ratio; PBM: Pharmacy Benefits Management; PO: Postoperative; RA: Rheumatoid arthritis; SD: Standard deviation; SGOT: Serum glutamic oxaloacetic transaminase; THA: Total hip arthroplasty; TIA: Transient ischemic attack; TJA: Total joint arthroplasty; TKA: Total knee arthroplasty; VA: Veterans Affairs; VASQIP: Veterans Affairs Surgical Quality Improvement Program.
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Microplasty Instrumentation was introduced to improve Oxford Mobile Partial Knee placement and preserve tibial bone in partial knee replacement (PKR). This might therefore reduce revision complexity. We aimed to assess the difference in use of revision total knee replacement (TKR) tibial components in failed Microplasty ver...
Background: Differences in susceptibility and response to infection between males and females are well established. Despite this, sex-specific analyses are under-reported in the medical literature, and there is a paucity of literature looking at differences between male and female patients with periprosthetic joint infection (PJI). Whether there ar...
Citations
... [7,8] Finally, rheumatoid arthritis and other forms of inflammatory arthritis are associated with excess mortality, especially due to cardiovascular disease. [14][15][16] This is evidenced in our overall cohort with a higher risk of death due to musculoskeletal diseases following both THA and TKA. The remaining musculoskeletal deaths were mostly joint infections and osteomyelitis, rare but devastating arthroplasty complications. ...
Background:
While studies have demonstrated that mortality after total hip (THA) and total knee (TKA) arthroplasty is better than the general population, the causes of death are not well established. We evaluated cause-specific mortality after THA and TKA.
Methods:
The study included population-based cohorts of patients who underwent THA (N = 2019) and TKA (N = 2259) between 1969 and 2008. Causes of death were classified using the International Classification of Diseases 9th and 10th editions. Cause-specific standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated by comparing observed and expected mortality. Expected mortality was derived from mortality rates in the United States white population of similar calendar year, age, and sex characteristics.
Results:
All-cause mortality was lower than expected following both THA and TKA. However, there was excess mortality due to mental diseases such as dementia following both THA (SMR 1.40, 95% CI 1.08, 1.80) and TKA (SMR 1.49, 95% CI 1.19, 1.85). There was also excess mortality from inflammatory musculoskeletal diseases in THA (SMR 3.50, 95% CI 2.11, 5.46) and TKA (SMR 4.85, 95% CI 3.29, 6.88). When the cohorts were restricted to patients with osteoarthritis as the surgical indication, the excess risk of death from mental diseases still persisted in THA (SMR 1.36, 95% CI 1.02, 1.78) and TKA (SMR 1.52, 95% CI 1.20, 1.91).
Conclusion:
THA and TKA patients experience a higher risk of death from mental and inflammatory musculoskeletal diseases. These findings warrant further research to identify drivers of mortality and prevention strategies in arthroplasty patients.
... It makes intuitive sense that risk of infection following TJA would be increased in patients with RA versus OA due to differences in the pathogenesis and medical management of these conditions. As a systemic autoimmune disease, RA is typically treated with immunosuppressive agents, including systemic corticosteroids, methotrexate, antimalarial drugs, and more recently, biologic agents, e.g., adalimumab and etanercept (33)(34)(35). Evidence regarding the effect of these medications on the rate of postoperative infection is inconsistent (34,36). ...
... As a systemic autoimmune disease, RA is typically treated with immunosuppressive agents, including systemic corticosteroids, methotrexate, antimalarial drugs, and more recently, biologic agents, e.g., adalimumab and etanercept (33)(34)(35). Evidence regarding the effect of these medications on the rate of postoperative infection is inconsistent (34,36). ...
Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is based on studies of patients with osteoarthritis (OA), with little being known about outcomes in patients with rheumatoid arthritis (RA). The objective of the present study was to review the current evidence regarding rates of THA/TKA complications in RA versus OA.
Data sources used were Medline, EMBase, Cinahl, Web of Science, and reference lists of articles. We included reports published between 1990 and 2011 that described studies of primary total joint arthroplasty of the hip or knee and contained information on outcomes in ≥200 RA and OA joints. Outcomes of interest included revision, hip dislocation, infection, 90-day mortality, and venous thromboembolic events. Two reviewers independently assessed each study for quality and extracted data. Where appropriate, meta-analysis was performed; if this was not possible, the level of evidence was assessed qualitatively.
Forty studies were included in this review. The results indicated that patients with RA are at increased risk of dislocation following THA (adjusted odds ratio 2.16 [95% confidence interval 1.52-3.07]). There was fair evidence to support the notion that risk of infection and risk of early revision following TKA are increased in RA versus OA. There was no evidence of any differences in rates of revision at later time points, 90-day mortality, or rates of venous thromboembolic events following THA or TKA in patients with RA versus OA. RA was explicitly defined in only 3 studies (7.5%), and only 11 studies (27.5%) included adjustment for covariates (e.g., age, sex, and comorbidity).
The findings of this literature review and meta-analysis indicate that, compared to patients with OA, patients with RA are at higher risk of dislocation following THA and higher risk of infection following TKA.
The objective of this paper is make recommendations for the perioperative management of antirheumatic treatment based on the best available evidence. A systematic review was performed including studies in which patients with rheumatic diseases treated with biological and non-biological disease-modifying antirheumatic drugs (DMARDs) had undergone surgery. A total of 5,285 studies were recorded, of which 27 were finally included. These contained information on 5,268 patients and 7,933 surgeries. The majority were women (mean age 55 years) were diagnosed with rheumatoid arthritis, and the most studied drug was methotrexate (MTX). The final recommendations include: maintaining treatment with MTX or leflunomide in the perioperative period in the absence of other risk factors for postoperative complications (Level of Evidence 1c, Grade D recommendation). Biological DMARDs should be temporarily suspended, or the surgery scheduled as far as possible from the last dose, and, if there were other risk factors a space at least two doses (Level of Evidence 2c; Grade D recommendation).
The objective of this paper is make recommendations for the perioperative management of antirheumatic treatment based on the best available evidence. A systematic review was performed including studies in which patients with rheumatic diseases treated with biological and non-biological disease-modifying antirheumatic drugs (DMARDs) had undergone surgery. A total of 5,285 studies were recorded, of which 27 were finally included. These contained information on 5,268 patients and 7,933 surgeries. The majority were women (mean age 55 years) were diagnosed with rheumatoid arthritis, and the most studied drug was methotrexate (MTX). The final recommendations include: maintaining treatment with MTX or leflunomide in the perioperative period in the absence of other risk factors for postoperative complications (Level of Evidence 1c, Grade D recommendation). Biological DMARDs should be temporarily suspended, or the surgery scheduled as far as possible from the last dose, and, if there were other risk factors a space at least two doses (Level of Evidence 2c; Grade D recommendation).
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