Article

A Systematic Review and Meta-Analysis Comparing Complications Following Total Joint Arthroplasty for Rheumatoid Arthritis Versus for Osteoarthritis

University of Toronto, Toronto, Ontario, Canada. .
Arthritis & Rheumatology (Impact Factor: 7.87). 12/2012; 64(12):3839-49. DOI: 10.1002/art.37690
Source: PubMed

ABSTRACT Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is based on studies of patients with osteoarthritis (OA), with little being known about outcomes in patients with rheumatoid arthritis (RA). The objective of the present study was to review the current evidence regarding rates of THA/TKA complications in RA versus OA.
Data sources used were Medline, EMBase, Cinahl, Web of Science, and reference lists of articles. We included reports published between 1990 and 2011 that described studies of primary total joint arthroplasty of the hip or knee and contained information on outcomes in ≥200 RA and OA joints. Outcomes of interest included revision, hip dislocation, infection, 90-day mortality, and venous thromboembolic events. Two reviewers independently assessed each study for quality and extracted data. Where appropriate, meta-analysis was performed; if this was not possible, the level of evidence was assessed qualitatively.
Forty studies were included in this review. The results indicated that patients with RA are at increased risk of dislocation following THA (adjusted odds ratio 2.16 [95% confidence interval 1.52-3.07]). There was fair evidence to support the notion that risk of infection and risk of early revision following TKA are increased in RA versus OA. There was no evidence of any differences in rates of revision at later time points, 90-day mortality, or rates of venous thromboembolic events following THA or TKA in patients with RA versus OA. RA was explicitly defined in only 3 studies (7.5%), and only 11 studies (27.5%) included adjustment for covariates (e.g., age, sex, and comorbidity).
The findings of this literature review and meta-analysis indicate that, compared to patients with OA, patients with RA are at higher risk of dislocation following THA and higher risk of infection following TKA.

1 Follower
 · 
105 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The role of total joint replacement surgery remains significant in the contemporary management of patients with rheumatoid arthritis (RA), despite the impact of potent biologic and synthetic disease-modifying drugs. Patients with RA have a systemic polyarticular disease, with extra-articular manifestations such as anemia as well as specific comorbidities such as cardiovascular disease, which require careful preoperative assessment for optimal outcomes and fewer adverse events. This review describes the important preoperative considerations taken to prepare a patient with RA for total hip and total knee replacement surgery.
    Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 05/2013; 19(4). DOI:10.1097/RHU.0b013e318289be22 · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this retrospective study was to evaluate the efficacy of a lateral parapatellar approach combined with a tibial tubercle osteotomy (TTO) in patients undergoing total knee arthroplasty (TKA) with non-correctable valgus knee osteoarthritis. We studied 53 consecutive patients (57 knees) who had a primary TKA via lateral parapatellar approach with a global step-cut "coffin" type TTO over a 10-year period. All patients had non-correctable grade II valgus deformity according to the Ranawat classification. The average age of patients was 71years (45 to 77) and the mean follow-up was 39months (20 to 98). Post-surgery, there was a significant improvement in knee extension (p=0.002), flexion (p=0.006), Knee Society Pain and Function Scores (p<0.001) and WOMAC Osteoarthritis Index (p<0.001). The tibiofemoral angle changed from a preoperative median value of 11deg (10 to 17) to a postoperative value of 3.75deg (0 to 9). Congruent patellar tracking was observed in all cases. All but one osteotomy united in a median period of 16.7weeks (9 to 28) and no hardware removal was required. One knee developed infection treated with two-stage reconstruction. A proximal tibial stress fracture also occurred in a patient on long-term bisphosphonate therapy. Lateral parapatellar approach along with TTO is an effective technique for addressing non-correctable valgus knee deformity during TKA.
    The Knee 06/2013; 21(1). DOI:10.1016/j.knee.2013.05.008 · 1.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success.
    09/2013; 2013:185340. DOI:10.1155/2013/185340
Show more

Preview

Download
3 Downloads