Rates and outcomes of total knee replacement for rheumatoid arthritis compared to osteoarthritis

Abstract

Background Total knee replacement (TKR) has been shown to perform differently in patients with rheumatoid arthritis (RA) when compared to osteoarthritis (OA). In this study, we compare the survivorship between these two groups and examine patient and prosthesis factors that impact the revision rate. Methods All RA and OA patients undergoing TKR in Australia from 1 September 1999 to 31 December 2016 were included. Revision rates were assessed using Kaplan–Meier estimates of survivorship. The cumulative percent revision analysed age, gender, prosthesis constraint and revision for infection. Results There were 541 744 TKR procedures performed including 7542 patients with RA. RA declined as the primary diagnosis from 2.4% of all TKR in 2003 to 0.9% in 2016. Male sex was an independent revision risk in RA patients (hazard ratio (HR) = 1.66, P < 0.001) and OA patients (3.5 years+: HR = 1.09 (1.04–1.15), P < 0.001). Male RA patients had a higher revision rate for infection than females (HR = 3.14, P < 0.001). Females with RA had a lower cumulative percent revision compared to OA females, but males showed no difference between diagnoses. Revision in RA patients was not influenced by age. Compared to OA, RA patients had a decreased revision rate for those aged <65 years, but not for patients aged ≥65 years. Conclusion The rate of revision after TKR in RA patients is lower than those with OA, but patients with RA are at increased risk of infection, particularly the male group. Prosthesis constraint had no influence on revision rate. Mortality in those undergoing TKR with RA was higher than in those with OA.

Inferior outcomes of primary total knee arthroplasty in patients with rheumatoid arthritis compared to patients with osteoarthritis

“…Patients suffering from RA were shown to have higher rates of pulmonary disease, cardiac morbidity, and higher mortality after surgery [21, 22]. Although direct comparison of mortality between studies is difficult owing to differences in demographic data such as age, sex, medical comorbidity, and ethnic difference, mortality after TKA in patients with RA is higher than that in patients with OA [6, 7, 23].…”

“…It is reasonable to expect that, as RA progresses, most patients undergoing TKA will experience other joint physical disabilities and complications. Although several studies have reported on TKA results in RA patients, limited data are available on the long‐term follow‐up outcomes of TKA in patients with RA compared to those with OA [6, 7].…”

Factors Affecting 30-Day Mortality following Primary Elective Total Knee Arthroplasty: A Database Study of 326,157 Patients

“…To the best of the authors' knowledge, there are no studies in the literature comparing mortality between patients with non-OA and OA preoperative diagnoses, although some studies have examined the impact of OA versus rheumatoid arthritis (RA) diagnoses on post-TKA mortality. 21 22 24 In an Australian study of 541,744 primary TKAs, Mooney et al 21 found that the rate of mortality between 0 and 5.5 years postoperative had a hazard ratio of 2.24 for patients with RA (95% CI: 2.06–2.46, p < 0.001) when compared with patients with OA. Our findings are consistent with this study, although the aforementioned study focused specifically on an RA diagnosis and longer-term mortality rather than all non-OA diagnoses and 30-day perioperative mortality measures.…”

“…5 9 10 11 12 13 14 Many comorbid conditions have also been associated with increased postoperative mortality, including disseminated cancer, 15 severe chronic kidney disease, 16 17 18 and hypoalbuminemia. 19 20 In addition, preoperative diagnoses may contribute to mortality rate, with studies finding that diagnoses such as rheumatoid arthritis 21 22 23 or osteoarthritis (OA) 24 are associated with increased risk of mortality. However, few studies have stratified mortality based on age, comorbidity burden, and preoperative diagnosis to elucidate mortality risk based on a specific patient's demographics and medical history.…”

Patient perspectives of pain and function after knee replacement: a systematic review and meta-synthesis of qualitative studies

“…People younger than 60 y needing TKR often require surgery for trauma-induced OA or for rheumatoid arthritis, both of which may result in different clinical trajectories. 50,75 Evidence also suggests that younger adults may have higher expectations of TKR outcome and pain and functional recovery than older adults after surgery. 76 In addition, perceptions of pain and function may be influenced by reduced activity levels in older adults following TKR as compared with younger adults, 39 and higher rates of surgical complications in older adults.…”