Objectives To assess the incidence of complications after total joint replacement in patients with inflammatory rheumatic disease receiving biologic disease-modifying antirheumatic drugs (bDMARDs).
Methods The study included 61 patients: 47 with rheumatoid arthritis, 12 with ankylosing spondylitis, 2 with psoriatic arthritis (47 female and 14 male), mean age 41,3±15 years. All patients were receiving the following bDMARDs in combination with methotrexate at average dose 12,2±5,3 mg/week for at least 6 months before surgery: infliximab – 31,1%, etanercept – 5%, adalimumab – 8,2%, tocilizumab – 6,6%, abatacept – 13,1%, rituximab – 36%. Next scheduled bDMARDs dose was cancelled at average 17,6±21,2 days before surgery, and bDMARDs administration restarted in 4 weeks after the operation (of rituximab – in 6 moths). Methotrexate was not discontinued. Total hip replacement was performed in 36 (59%) patients, knee replacement – in 23 (37,7%), shoulder and elbow replacement – in 2 patients (3,3%).
Results No infectious complications were documented within 3 months after surgery. There was a single case of dislocation of endoprosthesis, complicated with thrombosis; 1 patient developed ligamentous instability, requiring revision of the endoprosthesis; and another one had a posttraumatic neuropathy. In 12 months after surgery 1 patient developed infection of endoprosthesis (1,6%), and another one - instability of the endoprosthesis. In 24 months one patient developed infection of the prosthetic joint.
Conclusions The incidence of complications after total joint replacement surgery in patients with inflammatory rheumatic diseases receiving bDMARDs was low, not exceeding the rate of complications in patients on standard therapy.
Disclosure of Interest None declared
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