Kompendium 2020 Forschung & Klinik

TOP-Studien
30
Rheumatoid Arthritis Disease
Activity and the Risk of Aseptic
Arthroplasty Loosening
Rheumatoid arthritis (RA) is characterised by typical joint inflammation
and synovitis, which, if not treated effectively, leads to joint
destruction and functional disability. Although new treatment
strategies improved long-term outcomes tremendously, rates of
total hip and knee arthroplasty (THA/TKA) in patients with RA
remain considerable.
As RA differs fundamentally from osteoarthrosis (OA) in terms of prognosis,
pathogenesis, and medical treatment, outcomes of total joint arthroplasty
(TJA) and rates of complications would be expected to be different between
these two diseases. Aseptic loosening is the most common cause for surgical
revision after TJA with far-reaching implications, including an exchange of the
implant associated with decreased function, loss of bone stock and an increased
risk for further complications. Reasons for aseptic loosening are not
fully understood, but local inflammation is suspected to play a crucial role.
Systemic inflammation in RA might influence this process of local inflammatory-mediated
osteolysis and could lead to higher aseptic loosening rates
in RA patients, especially in those with increased inflammatory activity. The
objective of this study was to assess the influence of RA disease activity on
the risk of aseptic loosening after TJA. Furthermore, we evaluated if antirheumatic
therapy has an influence on the risk of aseptic loosening. Additionally,
we analysed the rates of radiographic aseptic loosening in OA patients, as a
control group without systemic inflammation.
Study:
Böhler C, Weimann P, Alasti F,
Smolen JS, Windhager R, Aletaha
D. Rheumatoid arthritis
disease activity and the risk of
aseptic arthroplasty loosening.
Semin Arthritis Rheum. 2020
Apr; 50(2):245–251
Patients and Methods
We ascertained data of 49 RA patients who underwent primary TJA with a
fully documented disease activity as well as a complete clinical and radiological
follow-up for analysis. Further we investigated a cohort of OA patient,
who were matched 2:1 for sex, age, date of surgery, and location of TJA as a
control group without systemic inflammation. We obtained demographic data,
comorbidities, antirheumatic therapy results, clinical and functional scores,
duration of surgery, and the type of implant. Due to the restricted number of
revision surgery because of aseptic loosening, we used radiological signs of
component loosening (RCL) as a more sensitive surrogate outcome parameter
for our main analysis. These included radiolucent lines (RLL) with a width
of ≥2mm, osteolysis exceeding 2mm in thickness, and implant migration of
≥2mm. Two independent observers, who were blinded for levels of disease ac-