Научно-практическая ревматология (Oct 2017)
LOCAL COMPLICATIONS OF HIP AND KNEE JOINT REPLACEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS
Abstract
Total joint replacement (TJR) in the presence of severe joint degradation and arthralgias in patients with rheumatic diseases (RDs) is one of the effective ways to improve the functional status of patients and their quality of life. In recent years, there has been an increase in the number of such knee and hip replacements worldwide. Despite advances in medicine in the 21st century, up to 5% of TJRs culminate in early complications, in which there are irreversible joint changes that cause joint functional loss and persistent pain and, in 2–3% of cases, require early re-revision surgery.Subjects and methods. The investigation included 2142 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent knee or hip joint replacement (KJR or HJR) at the V.A. Nasonova Research Institute of Rheumatology during the period 1998 to 2016: HJR in 1177 patients and KJR in 965. The patients with RA had 467 HJRs and 651 KJRs (a total of 1118 operations). A comparison group consisted of patients with OA who underwent710 HJRs and 314 KJRs (a total of 1024 operations). Postoperative surgical complications, such as superficial or deep suppuration, joint dislocation, periprosthetic fractures, sciatic and/or peroneal neuropathies, aseptic instability of endoprosthesis components, and complications of wound and ligamentous apparatus, were considered within 2 years after surgeryResults and discussion. Overall, the frequency of local complications after HJR and KJR was comparable and amounted to 7.22 and 7.25%, respectively (p=0.83), but their pattern greatly differed: there were a larger number of periprosthetic fractures after HJR than after KJR (3.48% and 0.93%; p <0.001). After KJR as compared to HJR, there were a greater number of infectious complications (1.66 and 0.27%; p <0.001) and a longer postoperative wound healing (1.87 and 0.42%; p <0.001). Comparison of the frequency of local complications revealed that there is a significant increase in patients with RA (29%) compared with those with OA (5.21%; p=0.001). The pattern of local complications was characterized by significant differences only in the frequency of periprosthetic fractures (p=0.028) and poor postoperative wound healing (p=0.019), which was higher than that in patients with RA. There was no statistically significant difference in the frequency of local complications after KJR in patients with RA and those with OA. Thus, surgical treatment of patients with RA requires a special approach that includes the competent perioperative medical management of a patient and the careful handling of the bone and surrounding tissues during surgery.
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