PERIPROSTHETIC INFECTION AFTER ENDOPROSTHETIC REPLACEMENT OF THE HIP JOINT IN PATIENTS WITH RHEUMATOID DISEASES
Periprosthetic infection (PI) in patients with rheumatoid diseases (RD) after total hip joint endoprosthesis (THJE) is a relevant problem of rheumoorphopedics that has not been solved yet. The relative assessment of PI incidence rate after THJE and treatment outcomes in patients with this complication is expected to be carried out. A total of 1201 THJE performed in 1069 patients with RD are considered. The female : male ratio was 3.6 : 1; the mean age was 49.6 years (range: 16 to 83 years). 323 patients had rheumatoid arthritis (RA); 124 patients had juvenile rheumatoid arthritis (JRA); 80 patients had ankylosing spondylitis (AS); 79 patients had systemic lupus erythematosus (SLE); 11 patients had systemic sclerodermatitis (SSD); 18 patients had psoriatic arthropathy (PsA); and 353 patients had osteoarthritis (OA). Other RD were revealed in 81 patients. PI were detected in 9 (0.84%) of 1069 patients with RD, including 7 (2.17%) of 323 patients with RA; 1 (0.8%) of 124 patients with JRA; and 1 (0.28%) of 353 patients with OA. No PI were detected in 81 patients who had other RD. An eightfold (in patients with RA) and a threefold (in patients with JRA) increase in PI compared to that in patients with OA attests to the high risk of this complication in patients with inflammatory as compared to the patients with degenerative RD. After integrated treatment (revision surgery, sanation, continuous irrigation with antibiotics/lavasept), the graft was preserved in OA patients; the complication was prevented in RA patients. Six patients will be subjected to repeated revision surgery; one patient died of diabetes complications after the graft had been removed. A significant increase in PI incidence rate after THJE in patients with RA and JRA as compared to that in OA patients allows one to regard inflammatory RD as risk factors of this complication. The low effectiveness of the procedure for integrated therapy for PI in RD patients indicates that it needs to be modernized.