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Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers.
类风湿关节炎患者全髋关节或全膝关节置换术后翻修、假体关节感染和死亡率的预测因素: 一项使用丹麦医疗登记的全国性队列研究。
DMARDs (biologic) epidemiology infections orthopaedic surgery rheumatoid arthritis
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摘要

OBJECTIVES:To investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.
METHODS:Register-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.
RESULTS:In total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57-0.89)), but increased risk of PJI (SHR=1.46 (1.13-1.88)) and death (HR=1.25 (1.01-1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65-3.40)), PJI (SHR=1.61 (0.70-3.69)) nor death (HR=0.75 (0.24-2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12-7.34)) and increasing DAS28 (HR=1.49 (1.01-2.20)) were risk factors for mortality.
CONCLUSION:Patients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.

译文

目的: 探讨全髋关节/全膝关节置换 (THA/TKA) 术后翻修风险 10 年、人工关节感染风险 (PJI) 和死亡风险的预测因素 (1) 类风湿性关节炎 (RA) 患者与骨关节炎 (OA) 患者的比较; 和 (2)RA 患者在手术前 90 天内接受生物疾病修饰抗风湿药物 (bDMARD) 治疗,而未接受治疗。
方法: 基于注册的队列研究使用丹麦国家患者注册、 DANBIO 风湿病学注册 (RA 特异性混杂因素和治疗发作) 和丹麦髋关节和膝关节置换注册。生存分析用于计算混杂调整的亚小时 (SHR) 和小时。
结果: 总共有 3913 名患有 THA/TKA 的 RA 患者与 120 名患有 OA 的 499 名患者相比。RA 患者的翻修风险降低 (SHR 0.71 (0.57-0.89)),但 PJI 风险增加 (SHR = 1.46 (1.13-1.88)) 和死亡 (HR = 1.25 (1.01-1.55))。在 DANBIO,1946年,345 名患有 THA/TKA 的 RA 患者在手术前 90 天内接受了 bDMARD 治疗。BDMARD 治疗的患者没有统计学上显著增加的翻修风险 (SHR = 1.49 (0.65-3.40)),PJI (SHR = 1.61 (0.70-3.69)) 与未治疗的患者相比,nor 死亡 (HR = 0.75 (0.24-2.33))。糖皮质激素暴露 (HR = 2.87 (1.12-7.34)) 和增加的 DAS28 (HR = 1.49 (1.01-2.20)) 是死亡率的危险因素。
结论: 与 THA/TKA 后的 OA 患者相比,RA 患者 10 年的翻修风险降低,而死亡风险和 PJI 风险增加。在本研究中,bDMARD 暴露与 PJI 和死亡风险的统计学显著增加无关。糖皮质激素暴露和疾病活动度的增加与死亡风险的增加有关。

Total knee arthroplasty

骨科 膝关节骨性关节炎治疗 手术
概述  :  

膝骨性关节炎是临床常见的老年群体疾病。该疾病会导致患者出现不同程度的疼痛,如不及时的进行相关治疗,将会会引发患者出现骨质增生的情况。严重的影响患者的正常生活与肢体运动。而目前采用全膝关节置换手术治疗后的患者能够有效的改善病情,为患者康复起到坚实保障。   临床意义   随着社会经济体系的发展与医疗水平的进步。患有各种疾病的患者基本已经能  够得到有效的得到救治。而老年群体因患膝关节骨关节炎以成为临床

Total /ˈtoʊtl/          

释义   adj. (total) 总的;彻底的;

n. (total) 总数

v. (total) 总数达;计算……的总和;(非正式)彻底毁坏(汽车);杀死,严重伤害(某人)

例句   Total disarmament was stipulated in the peace treaty. 全面解除武装是和平协议的必要条件。

 

knee 英 /niː/  美 /niː/         

释义   n. 膝盖,膝

vt. 用膝盖碰

n. (Knee)人名;(英)尼

例句   The boy fell and scraped the skin off his knee. 那男孩跌倒了,膝盖表面的皮肤被擦伤了。

 

arthroplasty /,ɑ:θrəu'plæsti/        

释义   n. [外科] 关节成形术;[外科] 关节造形术

例句   There are numerous factors that affect functional outcome in patients following hip arthroplasty of any type. 有大量的因素影响任何类型髋关节置换术后患者的功能结果。

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