Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients

Lee, Yung‐Heng; Ko, Po-Yun; Kao, Su-Ling; Lin, Mei‐Chen; Wei, James Cheng‐Chung

doi:10.1016/j.arth.2020.06.085

Cited by 16 publications

(13 citation statements)

References 40 publications

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“…Hip replacement can effectively relieve the joint pain, correct the deformity and recover and improve the joint motor function of patients, thus it is the most effective surgical intervention for elderly patients with hip diseases [1][2] . According to statistics, the incidence rate of postoperative cognitive dysfunction in elderly surgical patients is as high as 38% [3] , posing a serious threat to the surgical effects and prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

Application Effects of Remimazolam and on Elderly Patients Undergoing Hip Replacement

Zhang¹,

Wang²,

Zhang³

et al. 2021

Preprint

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Objective To explore the anesthetic and analgesic effects of remimazolam and propofol in elderly patients undergoing hip replacement and their effects on respiratory and circulatory systems, stress and cognitive function. Methods 60 elderly patients undergoing elective hip replacement in the hospital were selected as the research subjects, and they were divided into the remimazolam group and the propofol group according to the admission sequence of patients. The remimazolam group was anesthetized with remimazolam, and the propofol group was anesthetized with propofol. The anesthesia-related indicators, perioperative pain degree [Visual Analogue Scale (VAS)], circulatory indicators [heart rate, mean arterial pressure (MAP)] before anesthesia (T0), immediately before laryngeal mask insertion (T1), at 5 min after laryngeal mask insertion (T2), at 30 min after laryngeal mask insertion (T3) and at 5 min after laryngeal mask removal (T4), stress response indicators (plasma epinephrine, norepinephrine, cortisol) before anesthesia induction and at 24 h and 72 h after surgery, cognitive function [Mini-Mental State Examination (MMSE)] and adverse reactions were compared between the two groups. Results Among the 60 enrolled patients, only 1 case was excluded due to withdrawal, thus 30 cases in the remimazolam group and 29 cases in the propofol group were included. There were statistically significant differences in the heart rate, MAP, plasma epinephrine, norepinephrine, cortisol and VAS score in the two groups from the aspects of interaction effect and time-point effect (P<0.05). The heart rate and MAP at T1, T2 and T3 in the two groups were significantly decreased compared with those at T0, but the heart rate and MAP in the remimazolam group at T1, T2 and T3 were significantly higher than those in the propofol group (P<0.05). There were no statistical differences in the anesthesia time, awakening time and extubation time between the remimazolam group and the propofol group (P>0.05). The levels of plasma epinephrine, norepinephrine and cortisol in the two groups were significantly higher at 24 h and 72 h after surgery than those before anesthesia induction, and the above levels were significantly lower in the remimazolam group than those in the propofol group (P<0.05). The VAS scores at each time point in the two groups were significantly reduced compared to before surgery, but there was no statistically significant difference between the two groups after surgery (P>0.05). The MMSE scores of the two groups were significantly lower at 1 d and 3 d after surgery compared with those before anesthesia induction, but the score in the remimazolam group was significantly higher than that in the propofol group (P<0.05). In addition, the incidence rates of adverse reactions were significantly lower in the remimazolam group compared to the propofol group (P<0.05). Conclusion Compared with propofol, remimazolam can achieve equivalent anesthetic and analgesic effects in elderly patients undergoing hip replacement. However, the latter one can significantly relieve respiratory and circulatory suppression, stress response and cognitive dysfunction, with good safety. Trial registration Clinical trial ethics committee of Hefei second people's Hospital：2021- scientific research-032 (September 6, 2021).

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Section: Introductionmentioning

confidence: 99%

Application Effects of Remimazolam and on Elderly Patients Undergoing Hip Replacement

Zhang¹,

Wang²,

Zhang³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Hip replacement can effectively relieve the joint pain, correct the deformity and recover and improve the joint motor function of patients, thus it is the most effective surgical intervention for elderly patients with hip diseases [ 1 , 2 ]. According to statistics, the incidence rate of postoperative cognitive dysfunction in elderly surgical patients is as high as 38% [ 3 ], posing a serious threat to the surgical effects and prognosis of patients.…”

mentioning

confidence: 99%

Application effects of remimazolam and propofol on elderly patients undergoing hip replacement

et al. 2022

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Objective To explore the anesthetic and analgesic effects of remimazolam and propofol in elderly patients undergoing hip replacement and their effects on respiratory and circulatory systems, stress and cognitive function. Methods Sixty elderly patients undergoing elective hip replacement in the hospital were selected as the research subjects, and they were divided into the remimazolam group and the propofol group according to the admission sequence of patients. The remimazolam group was anesthetized with remimazolam, and the propofol group was anesthetized with propofol. The anesthesia-related indicators, perioperative pain degree [Visual Analogue Scale (VAS)], circulatory indicators [heart rate, mean arterial pressure (MAP)] before anesthesia (T0), immediately before laryngeal mask insertion (T1), at 5 min after laryngeal mask insertion (T2), at 30 min after laryngeal mask insertion (T3) and at 5 min after laryngeal mask removal (T4), stress response indicators (plasma epinephrine, norepinephrine, cortisol) before anesthesia induction and at 24 h and 72 h after surgery, cognitive function [Mini-Mental State Examination (MMSE)] and adverse reactions were compared between the two groups. Results Among the 60 enrolled patients, only 1 case was excluded due to withdrawal, thus 30 cases in the remimazolam group and 29 cases in the propofol group were included. There were statistically significant differences in the heart rate, MAP, plasma epinephrine, norepinephrine, cortisol and VAS score in the two groups from the aspects of interaction effect and time-point effect (P < 0.05). The heart rate and MAP at T1, T2 and T3 in the two groups were significantly decreased compared with those at T0, but the heart rate and MAP in the remimazolam group at T1, T2 and T3 were significantly higher than those in the propofol group (P < 0.05). There were no statistical differences in the anesthesia time, awakening time and extubation time between the remimazolam group and the propofol group (P > 0.05). The levels of plasma epinephrine, norepinephrine and cortisol in the two groups were significantly higher at 24 h and 72 h after surgery than those before anesthesia induction, and the above levels were significantly lower in the remimazolam group than those in the propofol group (P < 0.05). The VAS scores at each time point in the two groups were significantly reduced compared to before surgery, but there was no statistically significant difference between the two groups after surgery (P > 0.05). The MMSE scores of the two groups were significantly lower at 1 d and 3 d after surgery compared with those before anesthesia induction, but the score in the remimazolam group was significantly higher than that in the propofol group (P < 0.05). In addition, the incidence rates of adverse reactions were significantly lower in the remimazolam group compared to the propofol group (P < 0.05). Conclusion Compared with propofol, remimazolam can achieve equivalent anesthetic and analgesic effects in elderly patients undergoing hip replacement. However, the latter one can significantly relieve respiratory and circulatory suppression, stress response and cognitive dysfunction, with good safety. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 31/12/2021 with the registration number ChiCTR2100055039.

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“…Control of long-term inflammatory arthritis may be associated with improved clinical outcomes including: (1) a reduction in the need for total joint arthroplasty (TJA) [6,12]; (2) a reduction in postoperative pain and swelling following a preoperative corticosteroid treatment [8]; (3) personalized reduction or maintenance of disease-modifying antirheumatic drug therapy may reduce postoperative inflammatory disease flares, which are commonly confused with PJI [2]; (4) reduction of post-TJA arthrofibrosis risk associated with articular inflammation [10]; and (5) reduction of cardiovascular complications associated with inflammatory diseases [1]. Finally, although the NICE guidelines for routine preoperative tests for elective surgery do not include inflammatory parameters [9], I believe that for TJA patients this may need to be reconsidered.…”

Section: Improving Diagnosis Of Rheumatic Diseasesmentioning

confidence: 99%

Screening For and Evaluation of Inflammation Prior to TJA Has Implications for Perioperative Care and Outcomes

Overman

2022

HSS Journal®

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An orthopaedic surgeon's goals for total shoulder arthroplasty (TSA) include preventing periprosthetic joint infection (PJI) and other complications, diagnosing and treating PJIs quickly, improving patient-reported outcomes, and engendering overall satisfaction with the elective surgery. A recent article in HSS Journal by Kopechek et al, "Factors Associated with Elevated Inflammatory Markers Prior to Surgery," studied preoperative elevations of C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) in patients undergoing TSA [5]. In investigating the surgical implications of elevated ESR and CRP, the authors concluded that "routine collection of ESR and CRP preoperatively may not be of benefit, as elevated values are common." As a rheumatologist, I question this conclusion and would like to suggest diagnostic and therapeutic implications of ESR and CRP screening prior to surgery.

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Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients

Cited by 16 publications

References 40 publications

Application Effects of Remimazolam and on Elderly Patients Undergoing Hip Replacement

Application Effects of Remimazolam and on Elderly Patients Undergoing Hip Replacement

Application effects of remimazolam and propofol on elderly patients undergoing hip replacement

Screening For and Evaluation of Inflammation Prior to TJA Has Implications for Perioperative Care and Outcomes

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