Rheumatoid Arthritis vs Osteoarthritis in Patients Receiving Total Knee Arthroplasty: Perioperative Outcomes

Abstract

There is a paucity of data available on perioperative outcomes of patients undergoing total knee arthroplasty (TKA) for rheumatoid arthritis (RA). We determined differences in demographics and risk for perioperative adverse events between patients suffering from osteoarthritis (OA) versus RA using a population-based approach. Of 351,103 entries for patients who underwent TKA, 3.4% had a diagnosis of RA. RA patients were on average younger [RA: 64.3 years vs OA: 66.6 years; p<0.001] and more likely female [RA: 79.2% vs OA: 63.2%; P<0. 001]. The unadjusted rates of mortality and most major perioperative adverse events were similar in both groups, with the exception of infection [RA: 4.5% vs. OA: 3.8%; P<0.001]. RA was not associated with increased adjusted odds for combined adverse events.

Thirty-day complications in rheumatoid patients following total knee arthroplasty

“…Danoff et al reviewed total knee arthroplasty considerations in rheumatoid arthritis and found that rheumatoid patients tend to be on average 10 years younger than OA patients when undergoing a TKA [5]. Stundner et al evaluated 351,103 TKAs and noted that RA patients undergoing surgery were younger (64 vs. 67 years; p<0.001), with a higher incidence of women (79 vs. 63 %; p<0.001) [15].…”

Have the annual trends of total hip arthroplasty in rheumatoid arthritis patients decreased?

“…On the other hand, Bozic et al (20) found that patient records were in line with coding comorbidity data from large administrative databases. The positive predictive value for a clinical diagnosis of RA, and the accuracy of the databases, may be strengthened since the patients diagnosed with RA by coding data from large databases required a surgical intervention (21,22). Furthermore, medications that patients were taking during their hospitalization were not reported in the NIS database, therefore information regarding RA patients' DMARD use could not be determined; however, biological agent monotherapy as a treatment plan has been reported in approximately 34% of RA patients (1) and methotrexate monotherapy treatment has been recorded in as many as 50% of RA patients (23).…”

Outcomes Research in Perioperative Medicine

“…Unlike osteoarthritis (OA), the more frequent condition leading to joint destruction, RA is regarded as a systemic disease with potentially detrimental effects on multiple organ systems, frequently requiring medication with immunosuppressant agents and/or steroids. Our group compared patients receiving total hip or knee arthroplasty for osteoarthritis or rheumatoid arthritis [39,40]. In knee arthroplasty recipients, unadjusted rates and adjusted odds for mortality and major complications were similar between OA and RA patients, with the exception of infection, which was more prevalent in RA [40].…”

“…Our group compared patients receiving total hip or knee arthroplasty for osteoarthritis or rheumatoid arthritis [39,40]. In knee arthroplasty recipients, unadjusted rates and adjusted odds for mortality and major complications were similar between OA and RA patients, with the exception of infection, which was more prevalent in RA [40]. However, in hip arthroplasty recipients, while mortality was not significantly different, higher overall odds for complications, need for mechanical ventilation, transfusion, prolonged hospitalization, and increased hospital charges were detected when comparing RA to OA patients, signifying its status as a condition influencing multiple organ systems and potentially complicating the perioperative period [39].…”