Patterns and associated risk of perioperative use of anti-tumor necrosis factor in patients with rheumatoid arthritis undergoing total knee replacement.
OBJECTIVE
The patterns and risks of perioperative use of anti-tumor necrosis factor (anti-TNF) medication in patients with rheumatoid arthritis (RA) are not well studied. We examined the patterns of perioperative anti-TNF use and risk of postoperative adverse events (AE) in patients undergoing total knee replacement (TKR).


METHOD
Retrospective cohort study with followup. RA cases within a TKR registry were identified by ICD-9 code (714.0) or self-report. Mailed questionnaires queried anti-TNF use and duration of RA. AE were determined by chart review and patient self-report, and included surgical site infection, pulmonary embolus, deep venous thrombosis, pneumonia, and any infection or re-operation within 6 months.


RESULTS
There were 268 TKR cases with RA. The stop time for anti-TNF preoperatively correlated with dosing schedule; restart time was after wound healing. There were 7 surgical site infections (3%), one (0.4%) of which was a deep joint infection in bilateral TKA requiring explant. The anti-TNF group had 3.26% (3/92) local site infection versus 2.10% (3/143) in the group without anti-TNF and this difference was not statistically significant (Fisher exact test, p = 0.68). The one deep joint infection was in the anti-TNF group. Six-month AE rate was 7.61% in the anti-TNF group versus 6.99% in the group without anti-TNF (Fisher exact test, p = 1.0).


CONCLUSION
There was a low risk of infection and perioperative adverse events in patients with RA receiving anti-TNF therapy who were undergoing TKR. This raises the question whether it is necessary to stop anti-TNF for a long period prior to surgery. Given the possible risks associated with stopping anti-TNF, including worsening of disease, further study is needed to determine optimal perioperative use of anti-TNF among patients with RA undergoing TKR.
['Johnson|Beverly K|BK|', 'Goodman|Susan M|SM|', 'Alexiades|Michael M|MM|', 'Figgie|Mark P|MP|', 'Demmer|Ryan T|RT|', 'Mandl|Lisa A|LA|']
D018501:Antirheumatic Agents D001172:Arthritis, Rheumatoid D019645:Arthroplasty, Replacement, Knee D004334:Drug Administration Schedule D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010146:Pain D019990:Perioperative Care D011788:Quality of Life D020127:Recovery of Function D012042:Registries D012086:Reoperation D012189:Retrospective Studies D018570:Risk Assessment D012720:Severity of Illness Index D013530:Surgical Wound Infection D011795:Surveys and Questionnaires D063189:Symptom Assessment D014409:Tumor Necrosis Factor-alpha
RHEUMATOID ARTHRITIS INFECTION SURGERY ARTHROPLASTY TUMOR NECROSIS FACTOR INHIBITORS