PDF(Pubmed)
Abstract：
BACKGROUND: Identifying rheumatoid arthritis patients at higher risk of complications after total hip arthroplasty could make perioperative management more effective. Here we examined whether disease activity is associated with risk of such complications.
METHODS: We retrospectively analyzed data for 337 rheumatoid arthritis patients at our medical center who underwent primary total hip arthroplasty. Rheumatoid arthritis patients were categorized according to the simplified disease activity index (SDAI), the values of which at admission and follow-up were averaged together. Logistic regression was used to examine associations of mean SDAI with rates of dislocation, infection, periprosthetic fracture and aseptic loosening. As controls, 337 osteoarthritis patients who did not have systemic inflammation and who underwent the same procedure were matched across numerous clinicodemographic variables.
RESULTS: Among the 337 rheumatoid arthritis patients, 38 (11.3%) had postoperative complications, the rates of which varied significantly from 0 to 17.5% (p = 0.003) among the four subgroups whose disease activity based on mean SDAI was categorized as high, moderate, low or in remission. Each 1-unit increase in mean SDAI was associated with a significant increase in risk of postoperative complications (OR 1.015, 95% CI 1.001-1.029, p = 0.035). Across all rheumatoid arthritis patients, rate of complications did not differ significantly between patients who received disease-modifying anti-rheumatic drugs or other treatments. Rates of dislocation, of infection or of all postoperative complications combined were significantly lower among osteoarthritis controls than among rheumatoid arthritis patients.
CONCLUSIONS: Greater mean SDAI is associated with higher risk of dislocation, infection and composite postoperative complications after total hip arthroplasty in rheumatoid arthritis patients. These patients show a significantly higher rate of postoperative complications than osteoarthritis patients, likely reflecting the influence of systemic inflammation. Disease activity should be reduced as much as possible in rheumatoid arthritis patients before they undergo total hip arthroplasty.
METHODS: We retrospectively analyzed data for 337 rheumatoid arthritis patients at our medical center who underwent primary total hip arthroplasty. Rheumatoid arthritis patients were categorized according to the simplified disease activity index (SDAI), the values of which at admission and follow-up were averaged together. Logistic regression was used to examine associations of mean SDAI with rates of dislocation, infection, periprosthetic fracture and aseptic loosening. As controls, 337 osteoarthritis patients who did not have systemic inflammation and who underwent the same procedure were matched across numerous clinicodemographic variables.
RESULTS: Among the 337 rheumatoid arthritis patients, 38 (11.3%) had postoperative complications, the rates of which varied significantly from 0 to 17.5% (p = 0.003) among the four subgroups whose disease activity based on mean SDAI was categorized as high, moderate, low or in remission. Each 1-unit increase in mean SDAI was associated with a significant increase in risk of postoperative complications (OR 1.015, 95% CI 1.001-1.029, p = 0.035). Across all rheumatoid arthritis patients, rate of complications did not differ significantly between patients who received disease-modifying anti-rheumatic drugs or other treatments. Rates of dislocation, of infection or of all postoperative complications combined were significantly lower among osteoarthritis controls than among rheumatoid arthritis patients.
CONCLUSIONS: Greater mean SDAI is associated with higher risk of dislocation, infection and composite postoperative complications after total hip arthroplasty in rheumatoid arthritis patients. These patients show a significantly higher rate of postoperative complications than osteoarthritis patients, likely reflecting the influence of systemic inflammation. Disease activity should be reduced as much as possible in rheumatoid arthritis patients before they undergo total hip arthroplasty.
摘要：
背景：确定类风湿关节炎患者在全髋关节置换术后发生并发症的风险较高，可以使围手术期处理更有效。在这里，我们检查了疾病活动是否与此类并发症的风险相关。
方法：我们回顾性分析了我们医疗中心337例接受初次全髋关节置换术的类风湿关节炎患者的数据。类风湿性关节炎患者根据简化疾病活动指数（SDAI）进行分类，入院时和随访时的平均值一起计算.Logistic回归用于检查平均SDAI与脱位率的关联，感染,假体周围骨折和无菌性松动。作为控制，337名没有全身性炎症且接受相同手术的骨关节炎患者在许多临床人口统计学变量中进行了匹配。
结果：在337名类风湿性关节炎患者中，38例（11.3%）有术后并发症，在基于平均SDAI的疾病活动被分类为高的四个亚组中，其比率从0到17.5%(p=0.003)显著变化，中度,低或缓解。平均SDAI每增加1个单位与术后并发症的风险显着增加相关（OR1.015，95％CI1.001-1.029，p=0.035）。在所有类风湿性关节炎患者中，在接受疾病缓解性抗风湿药或其他治疗的患者之间,并发症发生率无显著差异.错位率,与类风湿性关节炎患者相比,骨关节炎对照组的感染或所有合并术后并发症的发生率明显较低.
结论：较大的平均SDAI与较高的脱位风险相关，类风湿性关节炎患者全髋关节置换术后的感染和复合术后并发症。这些患者的术后并发症发生率明显高于骨关节炎患者，可能反映了全身性炎症的影响。在接受全髋关节置换术之前，类风湿性关节炎患者应尽可能减少疾病活动。
方法：我们回顾性分析了我们医疗中心337例接受初次全髋关节置换术的类风湿关节炎患者的数据。类风湿性关节炎患者根据简化疾病活动指数（SDAI）进行分类，入院时和随访时的平均值一起计算.Logistic回归用于检查平均SDAI与脱位率的关联，感染,假体周围骨折和无菌性松动。作为控制，337名没有全身性炎症且接受相同手术的骨关节炎患者在许多临床人口统计学变量中进行了匹配。
结果：在337名类风湿性关节炎患者中，38例（11.3%）有术后并发症，在基于平均SDAI的疾病活动被分类为高的四个亚组中，其比率从0到17.5%(p=0.003)显著变化，中度,低或缓解。平均SDAI每增加1个单位与术后并发症的风险显着增加相关（OR1.015，95％CI1.001-1.029，p=0.035）。在所有类风湿性关节炎患者中，在接受疾病缓解性抗风湿药或其他治疗的患者之间,并发症发生率无显著差异.错位率,与类风湿性关节炎患者相比,骨关节炎对照组的感染或所有合并术后并发症的发生率明显较低.
结论：较大的平均SDAI与较高的脱位风险相关，类风湿性关节炎患者全髋关节置换术后的感染和复合术后并发症。这些患者的术后并发症发生率明显高于骨关节炎患者，可能反映了全身性炎症的影响。在接受全髋关节置换术之前，类风湿性关节炎患者应尽可能减少疾病活动。
