Lai Yahao, Tang Haiwei, Ding Zichuan, Huang Chao, Cai Yongrui, Luo Zeyu, Zhou Zongke
Department of Orthopaedic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Road, Wuhou district, Chengdu, Sichuan province, 610041, China.
J Orthop Surg Res. 2024 Jul 31;19(1):455. doi: 10.1186/s13018-024-04924-4.
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.
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.
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.
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.
识别全髋关节置换术后并发症风险较高的类风湿关节炎患者可使围手术期管理更有效。在此，我们研究了疾病活动度是否与此类并发症风险相关。
我们回顾性分析了在我们医疗中心接受初次全髋关节置换术的337例类风湿关节炎患者的数据。类风湿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SDAI值取平均值。采用逻辑回归分析平均SDAI与脱位、感染、假体周围骨折和无菌性松动发生率之间的关联。作为对照，选取337例无全身炎症且接受相同手术的骨关节炎患者，在多个临床人口统计学变量上进行匹配。
在337例类风湿关节炎患者中，38例（11.3%）出现术后并发症，在根据平均SDAI分为高疾病活动度、中度、低度或缓解的四个亚组中，并发症发生率从0%到17.5%有显著差异（p = 0.003）。平均SDAI每增加1个单位，术后并发症风险显著增加（OR 1.015，95% CI 1.001 - 1.029，p = 0.035）。在所有类风湿关节炎患者中，接受改善病情抗风湿药物或其他治疗的患者并发症发生率无显著差异。骨关节炎对照组的脱位、感染或所有术后并发症合并发生率显著低于类风湿关节炎患者。
类风湿关节炎患者全髋关节置换术后，较高的平均SDAI与脱位、感染及复合术后并发症风险增加相关。这些患者术后并发症发生率显著高于骨关节炎患者，可能反映了全身炎症的影响。类风湿关节炎患者在接受全髋关节置换术前应尽可能降低疾病活动度。
