RISK-FACTORS FOR EARLY WOUND COMPLICATIONS AFTER ORTHOPEDIC-SURGERY FOR RHEUMATOID-ARTHRITIS

Objective. To identify risk factors for the occurrence of early wound complications following orthopedic surgery in patients with rheumatoid arthritis (RA).Method. We reviewed records of patients with RA underg oing joint surgery to identify predictors of the following early posto perative surgical outcomes: (1) prolonged drainage; (2) wound cellulit is; (3) wound dehiscence; (4) suture abscess; and (5) superficial or d eep wound infection. Results. During the study, 204 patients with RA u nderwent 119 total knee replacements, 105 total hip replacements and 1 43 procedures of other joints, for a total of 367 orthopedic surgeries . A total of 57 complications were observed (15.9%) of which 26 were c onsidered major (7%). Of the 230 total arthroplasties of the hip, knee , shoulder or elbow, 3 were followed by early deep wound infections (1 .3%). In univariate analyses, factors significantly related to the occ urrence of complications included Hispanic ethnicity [relative risk (R R) 1.43, 95% confidence interval (CI) 1.16 to 1.78], and preoperative use of azathioprine (RR 2.13, 95% CI 1.04 to 4.37). Complications were less frequent among patients given methotrexate, but the difference w as not significant. Operative blood loss was inversely related to the occurrence of complications. In the multivariate model, the only signi ficant predictors of complications were Hispanic ethnicity (RR 2.86, 9 5% CI 1.43 to 5.56) and operative blood loss (RR 0.50/liter lost, 95% CI 0.29 to 0.86). Conclusions. We were unable to demonstrate an indepe ndent effect of antirheumatic therapy at the time of surgery on the oc currence of postoperative wound complications. Our study suggests that patients with Rtl of Hispanic ethnicity may be at increased risk of d eveloping postoperative wound complications following orthopedic surge ry. Further study is necessary to explain the mechanism of increased c omplications in this population.