1. ACP PRESENTATION 2012 – Steroids and Leflunomide, Not Biologics Are The Major Risk Factors For Infection Following Total Joint Arthroplasty Ranjani Somayaji B.Sc.PT., MD

2. Disclaimer  Wishing I had one?...  Residency Salary?

3. Background  Rheumatoid arthritis (RA) patients are at risk for infectious complications following orthopedic procedures due to underlying co-morbidities & RA treatment  The effect of biologic therapies on the risk of infections is still controversial… Goh L, Jewell T, Laversuch C & Smanta A. Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing orthopaedic surgery? A systematic review of the evidence. Rheumatol Int 2012;32:5-13.

4. Objective  To determine whether biologic therapies increase the risk of post- operative infection (surgical site or any site) in RA or adult juvenile idiopathic arthritis (JIA) patients undergoing hip or knee total joint arthroplasty

5. Methods  Subjects: RA/JIA undergoing hip or knee TJA between January 1, 2000 – December 31, 2010  Total of 381 procedures in 259 patients performed  Demographic + clinical data collected for up to 1 year

6. Hypothesis  Patients with RA on biologic therapy will have an increased incidence of post-operative infection following hip or knee TJA as compared with RA patients on standard disease modifying agents…

7. Table 1

8. Results – Part 1 Relative Risk for Infection Following Total Joint Arthroplasty by Therapy

9. Results – Part 2 Relative Risk for Infection Following Total Joint Arthroplasty by Comorbidity

10. Discussion  Biologic therapy & underlying co-morbidities do not confer an increased risk of post-operative infection in RA patients undergoing hip or knee total joint arthroplasty  Moderate to high dose steroids & leflunomide increase the risk of infection  Limitations…  Future studies….

11. QUESTIONS? Thank you to Dr. Liam Martin & Dr. Cheryl Barnabe