Rheumatoid Arthritis Versus Osteoarthritis in Patients Receiving Revision Total Knee Arthroplasty in the United States: Increased Perioperative Risks? A National Database-Based Propensity Score–Matching Study

Abstract

Background: The impacts of rheumatoid arthritis (RA) on perioperative risks among patients undergoing revision total knee arthroplasty (rTKA) have not been investigated yet. Thus, we hypothesized that patients with RA sustained increased perioperative risks and higher resource consumption burdens as compared to patients with osteoarthritis (OA) during the perioperative period.Patients and Methods: The National Inpatient Sample (NIS) database was used to compare the demographic characteristics, major inhospital complications, resource consumptions, and in-hospitalization mortality between patients with RA and OA after rTKA. A 1:1 propensity score-matching, x 2 test, independence-sample T-test, and logistic regression analysis were done in statistical analyses to answer our hypotheses.Results: 4.3% (6363/132,405) of rTKA patients were diagnosed with RA. They tended to be women and received revision for infection but with similar ages as compared to patients with OA. Except for acute postoperative anemia (odds ratio [OR] = 1.196), blood transfusion (OR = 1.179), prolonged hospitalization (OR = 1.049), and higher total cost (OR = 1.145), patients with RA sustained decreased odds of acute renal failure (OR = 0.804) and urinary complications (OR = 0.467). Besides, the other observed in-hospital complications showed no differences between patients with RA and OA. Conclusion:Despite consuming greater in-hospital resources, patients with RA did not suffer increased odds of most in-hospital complications and in-hospital mortality for a revision TKA during the perioperative period. Compared with patients with OA, patients with RA sustained equivalent perioperative risks in the United States between 2002 and 2014.

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

“…The main cause of end-stage arthritis is osteoarthritis (OA), which accounts for 90–97% of the primary indication for TKA, followed by rheumatoid arthritis (RA) [ 4 , 5 ]. Outcomes following TKA are generally unexceptionable, with low complication rate and high satisfaction [ 6 ]. However, some complications including infection, revision, venous thromboembolism (VTE), even death have been troubling surgeons significantly [ 7 – 9 ].…”

“…While most TKA operations are performed in patients with OA, which is the most common form of arthritis, they are also efficient in treating progressive joint destruction of the knee in patients with RA [ 6 , 16 ]. Therefore, numerous previous studies with respect to outcomes of TKA is relied on the experience in patients with OA [ 3 , 17 ].…”

“…Therefore, numerous previous studies with respect to outcomes of TKA is relied on the experience in patients with OA [ 3 , 17 ]. Both patients with RA and OA can be treated with TKA, but RA is essentially different from OA in terms of pathogenesis, prognosis, and medical therapy, so conceivable differences in TKA outcomes would be expected [ 6 , 18 ].…”

“…However, few studies have inquired whether there are differences in outcomes for patients with RA versus OA. Some previous meta-analyses have demonstrated that TKA can improve the outcomes of patients with RA, but compared with OA, patients with RA are at higher risk of complications after TKA [ 6 , 19 ]. However, these studies analyzed a few outcomes, and some literatures were older, and some literatures did not set control group, so the results obtained are controversial.…”

Duloxetine for rehabilitation after total knee arthroplasty: a systematic review and meta-analysis

“…Total knee arthroplasty (TKA) is one of the most common surgical procedures worldwide 1 . It is used for patients with end-stage knee osteoarthritis and rheumatoid arthritis 2 , 3 . There are over 700 thousand TKAs every year in the USA 4 , ~95 thousand in Australia 5 , and 17 thousand in Germany, and the incidence rate of TKA is expected to increase 6 .…”