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Researcher: Findings support halting disease-modifying drugs in arthroplasty patients with inflammatory bowel disease
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NEW ORLEANS — In a study of patients with chronic inflammatory bowel disease who underwent either primary or revision hip or knee arthroplasty, researchers found a 2.2% incidence of periprosthetic joint infection. They attributed this low rate to a protocol that stops disease-modifying immunosuppressant therapy perioperatively.
“We think that comorbidity management is key in the prevention of complications. Optimization will reduce these complications and the costs associated with it,” Camilo Restrepo, MD, said during his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting, here. “We think that halting disease modifying drugs may be the reason why we get a low incidence of periprosthetic joint infection in these patients, but we still think that there is a need for a multicenter, prospective study to be conducted.”
Restrepo and his colleagues Javad Parvizi, MD, FRCS, and Jeffrey Oliver, BS, conducted a retrospective database review to identify 449 primary and revision hip and knee replacements performed at their institution during a 12-year period in patients with chronic inflammatory bowel disease or related irritable bowel and colon conditions. Using ICD-9 codes, the investigators found 10 cases of periprosthetic joint infection (PJI) in these patients. Nine cases occurred with knee procedures and one case occurred with a hip procedure.
“The incidence of periprosthetic joint infection in patients with chronic inflammatory bowel disease is close to 2.2%, and it was all in primaries — not in revisions. The incidence of non-periprosthetic complications was close to 12% and most of them were hematologic complications,” Restrepo said.
He cited his institution’s protocol, which halts disease-modifying immunosuppressant agents 4 weeks prior surgery and 8 weeks after surgery, as a possible cause of the low PJI rate.
“This is reinforced by the fact that out of the 10 infections that we saw, only one happened during that 8-week period and all the other nine infections happened once the patients were already back on their immunosuppressing agents,” Restrepo said.
Reference:
Restrepo C. Paper #8. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 11-15, 2014; New Orleans.
Disclosure: Restrepo has no relevant financial disclosures.