Rheumatoid Arthritis Does Not Increase Risk of Short-term Adverse Events after Total Knee Arthroplasty: A Retrospective Case-control Study.

LoVerde ZJ1, Mandl LA1, Johnson BK1, Figgie MP1, Boettner F1, Lee YY1, Goodman SM2.

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Abstract

OBJECTIVE:

More adverse events (AE) are reported after total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA) than for patients with osteoarthritis (OA). This study evaluates 6-month postoperative AE in a high-volume center in a contemporary RA cohort.

METHODS:

Patients with RA in an institutional registry (2007-2010) were studied. AE were identified by self-report and review of office and hospital charts. Subjects with RA were matched to 2 with OA by age, sex, and procedure. RA-specific surgical volume was determined. Baseline characteristics and AE were compared and analyzed.

RESULTS:

There were 159 RA TKA and 318 OA. Of the patients with RA, 88.0% were women, 24.5% received corticosteroids, 41.5% received biologics, and 67% received nonbiologic disease-modifying antirheumatic drugs (DMARD). There was no difference in comorbidities. RA-specific surgical volume was high; 64% of cases were performed by surgeons with ≥ 20 RA cases during the study period. Patients with RA had worse baseline pain and function and lower perceived health status (EQ-5D 0.59 vs 0.65, p < 0.01). There were no deep infections in either group and no difference in superficial infection (9.4% RA vs 10.1% OA, p = 0.82), myocardial infarction (0.7% RA vs 0% OA, p = 0.33), or thromboembolism (1.3% RA vs 0.6% OA, p = 0.60).

CONCLUSION:

In a high-volume center, with high RA-specific experience, RA does not increase postoperative AE. Despite worse preoperative function and high steroid and DMARD use, complications were not increased. However, further study to determine generalizability is needed.