A systematic review and meta-analysis comparing outcomes following total knee arthroplasty for rheumatoid arthritis versus for osteoarthritis

Abstract

Purpose Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA. Methods Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Results Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24–2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37–3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61–0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78–0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60–2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54–0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01–0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47–1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79–2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87–1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56–5.48; P = 0.34) between the groups. Conclusion Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.

Functional results of total knee prosthesis in the treatment of rheumatoid arthritis: A case report of 64 patients

“…In Young Kyun Woo's series [3], the mean IKS score before surgery was 91. Lee et al [12] concluded that TKA has emerged as one of the most effective surgical procedures for reducing pain and improving physical function in RA patients despite the difficulties often encountered due to poor soft-tissue healing, higher rates of deep wound infection, severe preoperative joint deformity and laxity, low bone stock and involvement of other multiple joints that prevent adequate rehabilitation.…”

A rare case of a median nerve schwannoma: Case report

“…There is no sex predilection for schwannomas [4] . Schwannomas can develop at any age, however they are often diagnosed in people between the ages of 20 and 50 [3] . The digital and radial nerves are particularly susceptible to schwannomas and the median nerve occurrence is rare [3] .…”

“…Schwannomas can develop at any age, however they are often diagnosed in people between the ages of 20 and 50 [3] . The digital and radial nerves are particularly susceptible to schwannomas and the median nerve occurrence is rare [3] . Despite being benign, schwannomas can still cause serious morbidity by compressing nearby tissues, hence surgical removal is the recommended course of action [4] .…”

“…While they can occur at any age, they are commonly found in middle-aged adults from 20 to 50 years old [2] . Clinically, features include a palpable mass with discomfort or pain and sensory and motor deficits depending on its location and size [3] . In this case report, we describe a rare case of a median nerve schwannoma in a young patient.…”

Feasibility and acceptability of a telerehabilitation intervention on patients undergoing total knee arthroplasty in Iran: randomised controlled trial protocol

“…TKA is a common surgical procedure aimed at alleviating pain and enhancing mobility in individuals with severe KOA. 49 As the average age of the population in Iran is increasing, and the country is experiencing an ageing population, 50 it is expected that a larger proportion of the population in future years will require TKA and similar procedures. However, many patients face challenges in attending in-person rehabilitation sessions due to transportation limitations and restricted access to rehabilitation facilities.…”