Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis
ABSTRACT Background and objectives: Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying individuals with RA, we compared the rates of complications among THA and TKA recipients with versus without RA. Methods: In patients with a first primary elective THA or TKA between 2002 and 2009, those with RA were identified with a validated algorithm: hospitalization with a RA diagnosis or 3 RA billing claims with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon or internist) over a 2y period. Recipients with diagnostic codes suggesting an inflammatory arthritis (IA), but not meeting RA criteria, were classified as having IA. All remaining patients were deemed to have OA. Cox proportional hazards, censored on death, were used to determine the relationship between arthritis type and the occurrence of specific complications adjusting for potential confounders (age, sex, co-morbidity and provider volume). Results: We identified 43,997 eligible THA recipients (3% RA) and 71,793 eligible TKA recipients (4% RA). TJA recipients with RA had higher age & sex-standardized rates of dislocation following THA (OA: 1.21%, RA: 2.45%) and infection following TKA (OA: 0.84%, RA: 1.26%). Controlling for potential confounders, recipients with RA remained at increased risk for dislocation within two years of THA (adjusted HR 1.91, p=0.001), and infection within two years of TKA (adjusted HR 1.47, p=0.03), relative to recipients with OA. Conclusions: Patients with RA are at higher risk for dislocation following THA and infection following TKA relative to those with OA. Further research is warranted to elucidate explanations, including the role of medication profile, implant choice, post-operative antibiotic protocol and method of rehabilitation following joint replacement. © 2013 American College of Rheumatology.
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ABSTRACT: For elderly patients with rheumatoid arthritis, aggressive immunosuppression can be difficult to tolerate, and surgery remains an important treatment option for joint pain and deformity. We sought to examine the epidemiology of surgical reconstruction for rheumatoid arthritis among older individuals who were newly diagnosed with the disorder. We identified a 5% random sample of Medicare beneficiaries (sixty-six years of age and older) newly diagnosed with rheumatoid arthritis from 2000 to 2005, and followed these patients longitudinally for a mean of 4.6 years. We used univariate analysis to compare the time from the diagnosis of rheumatoid arthritis to the first operation among the 360 patients who underwent surgery during the study period. In our study cohort, 589 procedures were performed among 360 patients, and 132 patients (37%) underwent multiple procedures. The rate of upper extremity reconstruction was 0.9%, the rate of lower extremity reconstruction was 1.2%, and knee arthroplasty was the most common procedure performed initially (31%) and overall (29%). Upper extremity procedures were performed sooner than lower extremity procedures (fourteen versus twenty-five months; p = 0.02). In multivariable analysis, surgery rates declined with age for upper and lower extremity procedures (p < 0.001). Knee replacement remains the most common initial procedure among patients with rheumatoid arthritis. However, upper extremity procedures are performed earlier than lower extremity procedures. Understanding the patient and provider factors that underlie variation in procedure rates can inform future strategies to improve the delivery of care to patients with rheumatoid arthritis. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.The Journal of Bone and Joint Surgery 03/2015; 97(5):403-10. DOI:10.2106/JBJS.N.00802 · 4.31 Impact Factor
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ABSTRACT: Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) may require total hip replacement (THR) or total knee replacement (TKR). The present study aimed to compare the demographic characteristics and medical costs of RA and OA patients from Taiwan who underwent either THR or TKR. The medical records of patients who had undergone THR or TKR from 1 January 1996 to 31 December 2010 were obtained from the Taiwan National Health Insurance Research Database (NHIRD). In all, we found 49 and 146 RA patients who received THR and TKR, respectively, and 1,191 and 6,574 OA patients who received THR and TKR, respectively. The gender, age, Charlson comorbidity index (CCI), hospital grade, age at registration in the catastrophic illness dataset, and medical utilisation costs of the different groups were compared. There were statistically significant differences in age, CCI score, drug costs and surgery costs between RA and OA patients. Joint replacement incidence was lower in RA patients than in OA patients, and among patients who underwent THR, total medical costs incurred were higher for RA patients than OA patients. RA patients who underwent THR incurred a significantly greater total medical utilisation cost in the outpatient department (3 months before surgery and 12 months after surgery) than OA patients who underwent THR. Analysis of Taiwan NHIRD with regard to patients who had undergone either THR or TKR indicated that RA patients were younger than OA patients, and that significantly more medical resources were used for RA patients before, during and after hospitalisation for these procedures.Singapore medical journal 01/2015; 56(1):58-64. DOI:10.11622/smedj.2015011 · 0.63 Impact Factor
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ABSTRACT: Both traditional and disease-related risk factors for venous thromboembolism (VTE) must be considered when assessing rheumatic disease patients preoperatively. While many studies suggest that patients with rheumatic diseases are at higher risk of VTE overall, studies in rheumatoid arthritis patients do not demonstrate an increased risk of postoperative VTE. Here, we review the literature on VTE risk in patients with rheumatoid arthritis, systemic lupus erythematosus, Behcet's disease, and vasculitis. The data suggest that disease activity is a driver of VTE risk. While rheumatoid arthritis patients undergoing elective arthroplasty are not at elevated VTE risk, patients with systemic lupus erythematosus and antiphospholipid antibody syndrome undergoing surgery have an elevated risk of postoperative VTE.Current Rheumatology Reports 02/2015; 17(2):488. DOI:10.1007/s11926-014-0488-6 · 2.45 Impact Factor