Factors Associated With Increasing Length of Stay for Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty

Abstract

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are cost-effective procedures that decrease pain and improve health-related quality of life for patients with advanced symptomatic arthritis, including rheumatoid arthritis (RA). Patients with RA have a longer length of stay (LOS) after THA or TKA than patients with osteoarthritis, yet the factors contributing to LOS have not been investigated. Purpose: We sought to identify the factors contributing to LOS for patients with RA undergoing THA and TKA at a single tertiary care orthopedic specialty hospital. Methods: We retrospectively reviewed data from a prospectively collected cohort of 252 RA patients undergoing either THA or TKA. Demographics, RA characteristics, medications, serologies, and disease activity were collected preoperatively. Linear regression was performed to explore the relationship between LOS (log-transformed) and possible predictors. A multivariate model was constructed through backward selection using significant predictors from a univariate analysis. Results: Of the 252 patients with RA, 83% were women; they had a median disease duration of 14 years and moderate disease activity at the time of arthroplasty. We had LOS data on 240 (95%) of the cases. The mean LOS was 3.4 ± 1.5 days. The multivariate analysis revealed a longer LOS for RA patients who underwent TKA versus THA, were women versus men, required a blood transfusion, and took preoperative opioids. Conclusion: Our retrospective study found that increased postoperative LOS in RA patients undergoing THA or TKA was associated with factors both non-modifiable (type of surgery, sex) and modifiable (postoperative blood transfusion, preoperative opioid use). These findings suggest that preoperative optimization of the patient with RA might focus on improving anemia and reducing opioid use in efforts to shorten LOS. More rigorous study is warranted.

Disease activity and flares after total knee arthroplasty in rheumatoid arthritis - Systematic review

“…Yasui et al, 21 in their study on predictive factors for TKA in RA, showed that when compared to patients who did not undergo TKA during the course of 1 year, those who presented with knee involvement (64% vs. 23%), high Steinbrocker stage (III/IV), higher initial DAS28 scores (5.17 vs. 4.10), higher CDAI (22.6 vs. 14.0), and mHAQ (1.00 vs. 0.60) underwent TKA. Morse et al, 22 showed that the main determinants influencing length of hospital following joint arthroplasty (THA/TKA) using multivariate analysis were blood transfusion after surgery, female sex, TKA, pre-operative opioid usage; all of which were found to significantly increase duration of hospital stay.…”

Cost and Complications in Rheumatoid Arthritis Patients Undergoing Primary Hip Arthroplasty: A National Inpatient Sample-Based Study

“…However, a study by Stundner et al found that the length of stay and cost of hospitalization were higher in total knee arthroplasty patients with RA [ 13 ]. In a retrospective single-center study by Morse et al, the authors explain that female sex, use of opiates preoperatively, and need for blood transfusions were higher in RA patients, and contribute to the difference in length of stay [ 14 ]. Our study also found that RA patients required more blood transfusions, but both the unmatched analysis and the matching analysis that used sex as a variable found a significant difference in length of stay.…”

Analysis of Risk Factors and Surgical Strategy of Knee Traumatic Arthritis after Internal Plate Fixation in the Treatment of Tibial Plateau Fracture

“…After the completion of the operation, 300 patients were followed up for 1 year, and the incidence of traumatic arthritis within 1 year after operation was calculated. Diagnostic criteria of knee traumatic arthritis [ 10 ]: (1) there was a history of trauma (surgery is also a history of external injury); (2) the early lesion was characterized by joint pain and discomfort, especially stiffness after exercise, which was improved after proper exercise massage, but did not overwork; (3) when the disease progresses to the later stage, there might be severe symptoms such as limitation of movement, repeated swelling of the joint, persistent pain and gradual aggravation, joint deformity, and effusion; (4) X-ray examination showed the narrowing of joint space and the formation of bone spur at the edge of subchondral articular surface sclerosis. For patients with severe condition, it could be characterized by irregular articular surface, bone end deformation, and loose body in the joint.…”