Prediction of infection after total knee arthroplasty in rheumatoid arthritis patients by evaluating various risk factor

Abstract

Introduction: Total knee arthroplasty (TKA) is a surgical procedure that provides pain relief and restores function for patients suffering from debilitating arthritis. Despite the overall success of the procedure, periprosthetic joint infection (PJI) is a rare but devastating complication andfound to be a major cause of TKA failure.An infected implant often requires removal, prolonged immobilization and antibiotic treatment and multistage surgery. Hence, prevention of infections in intraoperative and postoperative stage is of paramount importance. Material and method: We have conducted a retrospective study in SreeSudheendra Medical Mission hospital, Ernakulum, Kerala. We collected the data from April 2014 to March 2018. In this duration we have found 89 cases of rheumatoid arthritis underwent TKA in 148 knees. We have collected and analysed demographic data and information regarding risk factors [like ESR, H/O Diabeties, steroid intake, blood transfusion, preop deformity, preop DMARDs, intraop soft tissue manipulation/finding, Albumin Globulin ratio (A/G)] associate with infection. Postoperatively we have followed our patient for the minimum period of 9 months period to 4 years. Result: We identified DMARDs (esp. methotraxate) and intraoperative manipulation like bone grafting, extra soft tissue release, Z-plasty of tendon as a risk factor for superficial periprosthetic infection (P value 0.05). Conclusion: These results guide our understanding of the relationship between infections and TKA in RA patient, and may help to prospectively identifyinghigh-risk patients, facilitating extra vigilance and implementation of preventive strategies in such patients.