Periprosthetic Joint Infection in Patients Receiving TNFα Antagonists

Tumor necrosis factor-α antagonists (anti-TNFα) have become increasingly more common as a treatment for rheumatoid arthritis (RA). However, there has been an increased incidence of severe infections in patients taking anti-TNFα therapy. We present a case series of RA patients treated with anti-TNFα therapy that had previously underwent TJA and subsequently developed periprosthetic infections. All patients had a well-functioning implant for a period of 1 to 14 years prior to the development of infection. Each patient underwent two to five different joint replacements, and four patients developed infection in multiple sites. The infections proved difficult to eradicate with four patients requiring multiple procedures, and one patient ultimately requiring a hemipelvectomy. This study suggests that periprosthetic infections acquired by patients on anti-TNFα therapy are challenging to eradicate and treat; highlighting the need for the establishment of guidelines for perioperative and long-term management of anti-TNFα therapy, and infection monitoring in joint replacement patients.