Jiang Wenyu, Xu Hong, Wang Xing, Jia Zhuangzhuang, Liao Chengzhi, Huang Qiang, Zhou Zongke, Pei Fuxing
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopaedics, The Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China.
Int Orthop. 2023 May;47(5):1189-1196. doi: 10.1007/s00264-023-05728-7. Epub 2023 Feb 20.
Total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) has been associated with an increased risk of periprosthetic joint infection, periprosthetic fractures, dislocations, and post-operative blood transfusion. However, higher post-operative blood transfusion is unclear whether it reflects peri-operative blood loss or is characteristic of RA. This study aimed to compare the complications, allogenic blood transfusion, albumin use, and peri-operative blood loss between patients who underwent THA because of RA or osteoarthritis (OA).
Patients undergoing cementless THA for hip RA (n = 220) or hip OA (n = 261) at our hospital between 2011 and 2021 were retrospectively enrolled. Deep vein thrombosis, pulmonary embolism, myocardial infarction, calf muscular venous thrombosis, wound complications, deep prosthetic infection, hip prosthesis dislocation, periprosthetic fractures, 30-day mortality, 90-day readmission, allogeneic blood transfusion, and albumin infusions were considered as primary outcomes, while secondary outcomes included the number of perioperative anaemia patients as well as total, intra-operative, and hidden blood loss.
Compared to the OA group, patients with hip RA showed significantly higher rates of wound aseptic complications, hip prosthesis dislocation, homologous transfusion, and albumin use. RA patients also showed a significantly higher prevalence of pre-operative anemia. However, no significant differences were observed between the two groups in total, intra-operative, or hidden blood loss.
Our study suggests that RA patients undergoing THA are at a higher risk of wound aseptic complications and hip prosthesis dislocation than patients with hip OA. Pre-operative anaemia and hypoalbuminaemia in patients with hip RA place them at a significantly higher risk of post-operative blood transfusion and use of albumin.
类风湿关节炎（RA）患者行全髋关节置换术（THA）与假体周围关节感染、假体周围骨折、脱位及术后输血风险增加有关。然而，较高的术后输血率尚不清楚是反映围手术期失血还是RA的特征。本研究旨在比较因RA或骨关节炎（OA）接受THA的患者之间的并发症、异体输血、白蛋白使用情况及围手术期失血情况。
回顾性纳入2011年至2021年期间在我院因髋关节RA（n = 220）或髋关节OA（n = 261）接受非骨水泥型THA的患者。深静脉血栓形成、肺栓塞、心肌梗死、小腿肌肉静脉血栓形成、伤口并发症、深部假体感染、髋关节假体脱位、假体周围骨折、30天死亡率、90天再入院率、异体输血及白蛋白输注被视为主要结局，而次要结局包括围手术期贫血患者数量以及总失血、术中失血和隐性失血。
与OA组相比，髋关节RA患者的伤口无菌并发症、髋关节假体脱位、同源输血及白蛋白使用发生率显著更高。RA患者术前贫血患病率也显著更高。然而，两组在总失血、术中失血或隐性失血方面未观察到显著差异。
我们的研究表明，与髋关节OA患者相比，接受THA的RA患者发生伤口无菌并发症和髋关节假体脱位的风险更高。髋关节RA患者的术前贫血和低白蛋白血症使其术后输血和使用白蛋白的风险显著更高。
