Anti-rheumatic treatment and prosthetic joint infection: An observational study in 494 elective hip and knee arthroplasties

Ylva Borgas, Anders Gülfe, Mikael Kindt, Anna Stefánsdóttir

Research output: Contribution to journalArticlepeer-review


Background: Surgical site infections are more frequent among patients with rheumatic disease. To what extent this is related to immunosuppressive antirheumatic drugs is unclear, as is the value of discontinuing medication perioperatively. The aim of study was to assess the rate of surgical site infections after knee and hip replacement in patients with inflammatory joint disease, with an emphasis on periprosthetic joint infection, and to investigate the influence of treatment with disease-modifying antirheumatic drugs (DMARDs) in this regard. Methods: Data were collected from 494 primary elective hip (51.4%) and knee arthroplasties, along with demographic and medication data. The primary outcome was surgical site infection during the first year after surgery. Results: In 78% (n = 385) of the cases the patient used 1 to 3 disease-modifying antirheumatic drugs perioperatively. Thirty-two percent (n = 157) of patients used a TNF-alpha inhibitor. The rate of surgical site infection was 3.8% (n = 19). The rate of periprosthetic joint infection was 1.4% (n = 7), all of which occurred after knee arthroplasty. Periprosthetic joint infection occurred in only 1 patient medicating perioperatively with a TNF-alpha inhibitor. Conclusion: Surgical site infections were not associated with ongoing medication with disease-modifying antirheumatic drugs. Due to the low event rate this should be interpreted with caution, but our center will maintain its routine of continuing treatment with TNF-alpha inhibitors perioperatively.

Original languageEnglish
Article number410
JournalBMC Musculoskeletal Disorders
Issue number1
Publication statusPublished - 2020 Jun 29

Subject classification (UKÄ)

  • Rheumatology and Autoimmunity

Free keywords

  • Anti-TNF
  • bDMARD
  • Infections
  • Orthopedic surgery


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