In a study of 1,150 patients in Brazil who underwent total joint arthroplasty (TJA), researchers aimed to understand why some patients appear to be more at risk for postoperative infections and mechanical complications.
The study, “Identification of high-risk groups for complication after arthroplasty: predictive value of patient’s related risk factors,” appears in the December 29, 2018 edition of The Journal of Orthopaedic Surgery and Research.
Martha Castano-Betancourt, Ph.D. with the Faculdade de Medicina de Jundiaí in Brazil, and study co-author explained the rationale for the study to OTW, “We have several patients that undergo arthroplasty every month, and although the protocols to prevent complications are followed, still there is some uncertainty about which patients are at higher risk. Beside patients with hip fracture, patients with osteoarthritis (OA) and rheumatoid arthritis (RA) are the most frequent recipients of prostheses.”
“I found some scientific articles referring to an increase in the risk of complications after arthroplasty in patients with RA, mainly infections; some articles referred to an increased risk of other types of complications in patients with OA, mainly cardiovascular. And there are common risk factors for both diseases (such as obesity).”
“However, very little has been studied to determine why the increased risk in RA (risk factors in RA patients) and how is that risk, compared to patients with osteoarthritis with the same factors. It is important for orthopedists to know this because they can make interventions to avoid or reduce complications.”
“In our population, all patients with RA had at least one other risk factor for complication (infection) before arthroplasty. In our cohort there were RA patients with three or even four other risk factors, principally for infections (history of respiratory infections, anemia, corticosteroids use, diabetes, between others).”
“The infection risk for patients with OA is lower when they are compared with patients with RA, even if they have some of those risk factors. It is also intriguing to find the association of hernia (principally inguinal) with higher risk for prosthesis dislocation. It is a novel risk factor that needs to be studied.”
“Prevention of complications after arthroplasty in patients with OA should emphasize systemic (principally cardiovascular) complications.”
“In patients with RA, prevention of complications should start several months before surgery (probably six months to one year prior to surgery) and should focus on infections and mechanical complications.”
“Assessment of the complication risk in these patients using our tool should be included in the protocol before surgery. Different aspects as to what kind of medication they are using (corticosteroids), history of other infections, uncontrolled periods of diabetes, anemia, between others risk factors should be evaluated and handled before surgery.”
“Even osteoporosis is a factor that can be treated before surgery to decrease osteolysis and other bone-related complications. Based on our results, we want to implement a protocol to detect the risk and implement prevention in the groups at higher risk.”
