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Authors: Pang-Hsin Hsieh1, Kuo-Chin Huang, Hsin-Nung Shih

This article provides an in-depth analysis of how longer durations of symptoms before debridement surgery and absence of antibiotic in bone cement for two-stage exchange was associated with treatment failure in RA patients with PJI. In addition, the work of Pang-Hsin et al. is invaluable for this topic as it is a breakthrough of a long research tradition in medicine about the risk of treatment failure. Their research has therefore come in handy to guide the study of Orthopedics regarding the retention of the prosthesis by debridement in delayed treatment.
Nonetheless, the research could be improved and advanced. Agencies of lower immunosuppressive potency such as hydroxychloroquine could be studied. Moreover, studying more patients with RA using other study designs could be done with this research as precedence. The discoveries may also enable researchers study fields such as surgery with the quality of surgery being an untouched variable in this research.

Authors: Peter Ljung’, SivBornmy and Henry Svensson

Publication date: 28-11-1994
Remarkably, the findings of this research are imperative on this topic as they became the primacy of the study and actual prognosis of elbow replacement in RA. Researcher's goals to determine the effect of early mobilization and lateral insertion of the prosthesis are vital for other succeeding studies in this field. Furthermore, this article provides an overview of incidences of wound healing complications on total elbow replacement, a tenet of this topic that is hard to estimate without prior study.
Regardless of the researchers’ careful methodology, attention to detail and lucid description of findings, their work could be improved through exhaustive study on the inflammatory response of the healing process and by use of larger samples of subjects fitting the inclusion criteria. Some new areas of study arise from this research. Such areas include studying the effect of prosthetic surgery procedures and postoperative regime on wound complications.
Authors: Ryan M. Garcia MD, Brian T. Hardy MD, MBA, Matthew J. Kraay MS, MD, Victor M. Goldberg MD

Publication date: 30th August, 2010

This article is vital in that their work was a success in confirming previously reported high failure rates following revision total knee arthroplasty in patients with RA. The researchers were able to confirm these findings in patients who were treated for either mechanical reasons or infection. This article shows great improvement in the subject matter as it provides a new framework for analyzing revision failure that is more advanced to previous methods such as the study of osteolytic lesions through a total joint arthroplasty database.
Even so, further research can be done a result of this article. Additional research could be done on the effect of the use of disease-modifying anti-rheumatic medications, which was surpassed in the research and high-dose corticosteroids on the risk of morbidity and mortality such patients. In addition, this study could be improved by looking into new areas such as the use of blinded radiographic analysis, a precept that was detoured in this study. The research could also be tried on a homogenous population and a bigger cohort.
Authors: Elie F. Berbari, Douglas R. Osmon, Mary C. T. Duffy, R. N. William Harmssen, Jayawant N. Mandrekar, Arlen D. Hanssen and James M. Steckelberg
Source: Clinical Infectious Diseases, Vol. 42, No. 2 (Jan. 15, 2006), pp. 216-223

The nature of surgical operation used and levels of treatment failure in RA patients with PJI

Noticeably, this article provides an ideal point of reference for this topic. The supposition of the work of Elie et al. (2005) that prosthetic joint infections in patients with RA are a staid complication of total joint arthroplasty is invaluable for my topic. This article clearly states and discusses comprehensively the authors’ purpose of writing, a vital aspect of improving the little information available on the outcome of medical and surgical treatments of prosthetic joint infection in patients with RA.
Astoundingly, further research can still be done as a result of this article. The authors’ argument could be extended to include a broader set of ideas such as the direct effect of therapeutic surgical modality on the subject matter. Additionally researchers could try eliminating debridement and retention to allow for the complete eradication of the biofilm present in the prosthesis and find out its effect on outcomes in patients with RA. A new lush area that comes into mind based on the discoveries is the study of effects of having and not having delayed reimplantation in resection arthroplasty on the complete eradication of prosthetic joint infection.

Works Cited

Berbari, Elie F., et al. "Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes." Clinical infectious diseases 42.2 (2006): 216-223.
Garcia, Ryan M., et al. "Revision total knee arthroplasty for aseptic and septic causes in patients with rheumatoid arthritis." Clinical Orthopaedics and Related Research® 468.1 (2010): 82-89.
Hsieh, Pang-Hsin, Kuo-Chin Huang, and Hsin-Nung Shih. "Prosthetic joint infection in patients with rheumatoid arthritis: an outcome analysis compared with controls." PloS one 8.8 (2013): e71666.
Ljung, Peter, Siv Bornmyr, and Henry Svensson. "Wound healing after total elbow replacement in rheumatoid arthritis Wound complications in 50 cases and laser-Doppler imaging of skin microcirculation." Acta Orthopaedica 66.1 (1995): 59-63.