Complications after endoprosthetic joint replacement in patients receiving genetically engineered biological agents

Abstract

Objective: to study the clinical features and to define the frequency of postoperative complications in patients with rheumatic diseases (RD) who had undergone endoprosthetic knee and hip joint replacement (EKJR and EHJR) during therapy with genetically engineered biological agents (GEBAs). Subjects and methods. The study included 37 patients with RD: 30 with rheumatoid arthritis (RA), 6 with ankylosing spondylitis (AS), and 1 with psoriatic arthritis (PsA). All the patients had indications for endoprosthetic joint replacement (EJR): evident deformity and dysfunction of the joint; pain unrelieved by analgesics and nonsteroidal antiinflammatory drugs; and low quality of life (QL). EHJR and EKJR were performed in 21 and 16 patients, respectively. Their mean age was 40.6+15.8 years (range 18 to 64 years); 78.4% were women; the mean duration of disease was 15 years. 73% patients received synthetic disease-modifying antirheumatic drugs (DMARDs); 68% took small-dose glucocorticosteroids (GCs). All the patients were on GEBA therapy: 16 patients on rituximab, 15 on infliximab, 1 on adalimumab, 3 on abatacept, and 2 on tocilizumab. The activity of RA was determined using DAS 28 scores, that of AS and PsA was estimated using BASDAI and DAS 4 scores, respectively; functional activity was calculated from HAQ scores; QL was defined using the EQ-5D questionnaire. Results. The diagnosis was established in 73% of the patients within the first 2 years after disease onset; at that time, half of them started receiving DMARD therapy. GEBAs were given to patients with high disease activity, inefficacy or intolerance of synthetic DMARDs at an average of 13 years of disease. Addition of GEBAs could lessen preoperative disease activity in the majority of patients (to moderate and low activities in 60 and 27% of the patients, respectively) and the activity remained high only in 13%. During their disease, 84% of the patients took small-dose GCs long (for 1 to 19 years); however, only 68% continued to receive this therapy within 6 months before surgery. In the period of 1 to 12 months following surgery, there was venous thrombosis in 1 (2.7%) patients and instability of the ligamentous apparatus in the replaced joint in 2 patients. No cases of replaced joint infection were found throughout the follow-up. Conclusion. The use of GEBAs made it possible to diminish disease activity in most patients, to reduce needs for GCs, and to perform EJR with a more favorable background. This therapy was not accompanied by the development of infectious complications at the site of prosthetic replacement.

Keywords

• endoprosthetic knee and hip joint replacement
• genetically engineered biological preparations_