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Updated: Jun 30, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Periprosthetic joint infections in patients with rheumatoid arthritis are associated with higher complication and
Lucio Cappelli Toledo de Araujo1,2, Anette Westerholt3, Amir N Sandiford4
1Department of Orthopaedic Surgery, ENDO Klinik Buch, Berlin, Germany. toledodearaujol@gmail.com.
Introduction:
Periprosthetic joint infection (PJI) remains the most devasting complication after total joint arthroplasty (TJA). There has been a significant focus on this topic in recently-published medical literature. However, relatively little has been published about PJI in patients with rheumatoid arthritis (RA), which are often physiologically frail and immunocompromised. A better understanding of PJI in this patient population is therefore crucial. The main aims of this paper are to (1) report complication and mortality rates in a cohort of PJI-RA patients; and (2) clinically characterize them.
Methods:
Medical and surgical records of all RA PJI patients treated surgically from 2003 to 2020 were retrospectively reviewed. Medical history, physical examination, reactive protein (CRP) level, procalcitonin, white blood cell (WBC) count, joint aspiration results, and cultures were used to determine PJI.
Results:
54PJIs, 49 of them chronic, were treated in 53RA patients. Mean patient age was 65 yrs. (range = 32-88); 33females and 20 males (one bilateral hip). The overall mortality rate was 18.9%(n = 10), with five deaths directly attributed to PJI. Staphylococci accounted for 34 infections (63%), while 11(20.4%) had multiorganism infections and six culture-negative PJI. At the end of treatment 79.6%(n = 43) still had an implanted TJR, 7.4% (n = 4) had spacers, 5.6%(n = 3) had undergone resection arthroplasty, 3.7%(n = 2) arthrodesis, and one each amputation and exarticulation.
Conclusions:
Mortality and specially complication rates were (are) high in this RA patients group presenting PJI. Delays to diagnosis and treatment may explain some of these poor outcomes.
Level Of Evidence:
A cohort level III retrospective study.
Insights
Periprosthetic joint infection (PJI) in rheumatoid arthritis (RA) patients has high complication and mortality rates. Early diagnosis and treatment are crucial for better outcomes in this vulnerable population.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Infectious Diseases
Background:
- Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty (TJA).
- Limited research exists on PJI specifically in rheumatoid arthritis (RA) patients, who are often frail and immunocompromised.
- Understanding PJI in RA patients is critical due to their unique physiological challenges.
Purpose of the Study:
- To report complication and mortality rates in a cohort of PJI patients with rheumatoid arthritis (RA).
- To clinically characterize patients experiencing PJI in the context of RA.
Main Methods:
- Retrospective review of medical and surgical records for RA patients with PJI from 2003 to 2020.
- PJI diagnosis based on medical history, physical examination, inflammatory markers (CRP, procalcitonin, WBC), joint aspiration, and cultures.
- Study design: Level III retrospective cohort study.
Main Results:
- 54 PJIs (49 chronic) were treated in 53 RA patients (mean age 65 years).
- Overall mortality rate was 18.9%, with 5 deaths directly attributed to PJI.
- Staphylococci were the most common pathogens (63%), followed by polymicrobial infections (20.4%).
Conclusions:
- Patients with rheumatoid arthritis (RA) experiencing periprosthetic joint infection (PJI) face high rates of mortality and complications.
- Delayed diagnosis and treatment likely contribute to these adverse outcomes.
- Further research and optimized management strategies are needed for this high-risk patient group.
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