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Zhang AR, Cheng QH, Yang YZ, Yang X, Zhang ZZ, Guo HZ. Meta-analysis of outcomes after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis. Asian J Surg 2024; 47:43-54. [PMID: 37777403 DOI: 10.1016/j.asjsur.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/27/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023] Open
Abstract
The purpose of this study was to compare the difference in functional scores and the incidence of complications after TKA between RA and osteoarthritis. The PubMed, MedLine, The Cochrane Library, Embase and Web of Science databases were searched for all clinical studies up to 15 March 2023 comparing outcomes after total knee replacement in patients with RA and OA, with two review authors independently screening the literature. A total of 7,820,115 (knee-counted) cases were included in 34 studies. The results of meta-analysis showed that the scores of the RA group were lower than that of the osteoarthritis group in the postoperative knee joint score [MD=-2.72,95%CI(-5.06,-0.38),P=0.02] and the postoperative knee joint function score [MD=-11.47,95%CI(-16.55,-6.39),P<0.00001], and the difference was statistically significant. The incidence of deep venous thrombosis (OR=0.84,95%CI(0.79,0.90),P<0.00001) and pulmonary embolism (OR=0.84,95%CI(0.78,0.91),P<0.00001) were significantly lower in RA than in osteoarthritis (P<0.00001). Compared with patients with osteoarthritis, patients with rheumatoid arthritis have lower knee society scores and functional scores after total knee arthroplasty, and a higher risk of prosthetic infection, loosening, and revision, but TKA can still effectively reduce pain in RA patients, Improve function and quality of life without increasing the risk of lower extremity venous thrombosis and pulmonary embolism. Therefore, total knee replacement can be used as a treatment option for patients with rheumatoid arthritis who have not responded to conservative treatment. Patients should fully understand the benefits and possible risks of total knee replacement and develop an individualized treatment plan.
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Affiliation(s)
- An-Ren Zhang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China.
| | | | - Yong-Ze Yang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
| | - Xin Yang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
| | - Zhuang-Zhuang Zhang
- First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, China; Gansu Provincial Hospital, Lanzhou, China
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Holzapfel DE, Thieme M, Kappenschneider T, Holzapfel S, Maderbacher G, Weber M, Grifka J, Meyer M. [Outcome of joint replacement in patients with underlying rheumatoid disease]. Z Rheumatol 2023; 82:825-833. [PMID: 37792031 PMCID: PMC10695889 DOI: 10.1007/s00393-023-01424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Artificial joint replacement is a meaningful treatment option for patients with advanced rheumatic degenerative joint diseases. The aim of this study was to investigate the influence of the underlying rheumatic diseases on postoperative complications and patient-reported outcome (PRO) after elective total joint replacement (TJR). MATERIAL AND METHODS In a retrospective analysis of 9149 patients with elective total knee or total hip arthroplasty (TKR and THR), complication rates and PRO of patients with and without rheumatic diseases (RD) were compared. Multivariate logistic regression models were used to determine whether the underlying rheumatic disease was an independent risk factor for various complications. RESULTS In the univariate analyses the RD patients had an increased risk of medical complications (7.1% vs. 5.2%; p = 0.028) and Clavien-Dindo grade IV complications (2.8% vs. 1.8%; p = 0.048) after TJR. This was confirmed in multivariate statistical analyses (p < 0.034). The rates for operative revisions and surgical complications were comparable (2.5% vs. 2.4%; p = 0.485). Analysis of the PRO showed a higher responder rate in patients with RD after TKR (91.9% vs. 84.5%, p = 0.039). In contrast, the responder rate in patients with RD after THR was comparable (93.4% vs. 93.2%, p = 0.584). CONCLUSION Despite increased postoperative complication rates, patients with underlying rheumatic diseases showed a comparable outcome 1 year after TJR. After TKR the RD patients showed even higher responder rates. Although RD patients are a vulnerable patient group, they can still benefit from joint replacement.
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Affiliation(s)
- Dominik Emanuel Holzapfel
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Max Thieme
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Tobias Kappenschneider
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Sabrina Holzapfel
- Department of Neonatology, Children's Hospital St. Hedwig Barmherzige Brüder, Medical Center, Regensburg, Deutschland
| | - Günther Maderbacher
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Markus Weber
- Center of Oncology, Hospital Barmherzige Brüder, Medical Center, Regensburg, Deutschland
| | - Joachim Grifka
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Matthias Meyer
- Medical Center, Department of Orthopaedic Surgery Asklepios Klinikum Bad Abbach, Regensburg University, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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Bounajem GJ, DeClercq J, Collett G, Ayers GD, Jain N. Does interaction occur between risk factors for revision total knee arthroplasty? Arch Orthop Trauma Surg 2023:10.1007/s00402-023-05107-2. [PMID: 37902892 DOI: 10.1007/s00402-023-05107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Several risk factors for revision TKA have previously been identified, but interactions between risk factors may occur and affect risk of revision. To our knowledge, such interactions have not been previously studied. As patients often exhibit multiple risk factors for revision, knowledge of these interactions can help improve risk stratification and patient education prior to TKA. MATERIALS AND METHODS The State Inpatient Databases (SID), part of the Healthcare Cost and Utilization Project (HCUP), were queried to identify patients who underwent TKA between January 1, 2006 and December 31, 2015. Risk factors for revision TKA were identified, and interactions between indication for TKA and other risk factors were analyzed. RESULTS Of 958,944 patients who underwent TKA, 33,550 (3.5%) underwent revision. Age, sex, race, length of stay, Elixhauser readmission score, urban/rural designation, and indication for TKA were significantly associated with revision (p < 0.05). Age was the strongest predictor (p < 0.0001), with younger patients exhibiting higher revision risk. Risks associated with age were modified by an interaction with indication for TKA (p < 0.0001). There was no significant interaction between sex and indication for TKA (p = 0.535) or race and indication for TKA (p = 0.187). CONCLUSIONS Age, sex, race, length of stay, Elixhauser readmission score, urban/rural designation, and indication for TKA are significantly associated with revision TKA. Interaction occurs between age and indication.
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Affiliation(s)
- Georges J Bounajem
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
- UT Southwestern Medical Center at Frisco, 12500 Dallas Parkway, 3rd Floor, Orthopaedic Surgery, Frisco, TX, 75033-9071, USA.
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Garen Collett
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gregory D Ayers
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Nitin Jain
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
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Qiao Y, Li F, Zhang L, Song X, Yu X, Zhang H, Liu P, Zhou S. A systematic review and meta-analysis comparing outcomes following total knee arthroplasty for rheumatoid arthritis versus for osteoarthritis. BMC Musculoskelet Disord 2023; 24:484. [PMID: 37312069 DOI: 10.1186/s12891-023-06601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/03/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA. METHODS Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). RESULTS Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24-2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37-3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61-0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78-0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60-2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54-0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01-0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47-1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79-2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87-1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56-5.48; P = 0.34) between the groups. CONCLUSION Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.
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Affiliation(s)
- Yongjie Qiao
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China
| | - Feng Li
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China
- Department of Orthopedics, The 943rd Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Wuwei, China
| | - Lvdan Zhang
- Department of Respiratory Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China
| | - Xiaoyang Song
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China
| | - Xinyuan Yu
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China
| | - Haoqiang Zhang
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China
| | - Peng Liu
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China
| | - Shenghu Zhou
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Gansu, Lanzhou, China.
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Inferior outcomes of primary total knee arthroplasty in patients with rheumatoid arthritis compared to patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2786-2792. [PMID: 34286348 DOI: 10.1007/s00167-021-06675-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications of total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) with those in patients with osteoarthritis (OA) over a minimum 10-year follow-up period. METHODS Between January 2007 and December 2009, 90 TKAs performed in 57 patients with RA (RA group) were retrospectively reviewed and matched with a control group of 180 TKAs performed in 114 patients with OA. The functional outcomes (Knee Society Score), activity levels (Koval grade), mortalities, implant survival rates, and complications were compared between the two groups with a minimum 10-year follow-up period. The mean follow-up periods were 12.3 years in the RA group and 12.6 years in the OA group. RESULTS The mean Knee Society knee scores in the RA and OA groups improved from 37.7 ± 5.4 to 38.2 ± 5.3 preoperatively to 72.9 ± 22.8 to 83.1 ± 11.0 points, respectively, at the final follow-up (p < 0.05). At the final follow-up, 38 of 48 (79.2%) in the RA group and 105 of 109 (96.3%) in the OA group (p < 0.05) were outdoor ambulatory patients. The cumulative mortality rates in the RA and OA groups were 15.8% (9/57) and 4.4% (5/114) (p < 0.05) at the final follow-up, respectively. Kaplan-Meier survivorship analysis with revision of either component as an endpoint in the RA and OA groups estimated 94.4% and 98.3% chance of survival for 10 years, respectively. CONCLUSION TKA in patients with RA had worse functional outcomes and higher mortality over a minimum 10-year follow-up period, compared with TKA in patients with OA. LEVEL OF EVIDENCE IV.
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Patient perspectives of pain and function after knee replacement: a systematic review and meta-synthesis of qualitative studies. Pain Rep 2022; 7:e1006. [PMID: 35558092 PMCID: PMC9088230 DOI: 10.1097/pr9.0000000000001006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/30/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Joint replacement surgery typically results in good clinical outcome, although some people experience suboptimal pain relief and functional improvement. Predicting surgical outcome is difficult. Objectives There is merit in better understanding patients' perspectives of pain and function to identify avoidable problems perceived to contribute to their outcome, to inform prognostic expectations, and to identify potential cointerventions to sit alongside surgery that might mitigate pain/functional problems. Here, we aimed to synthesise the available literature exploring perspectives of people with knee osteoarthritis about their pain and function following joint replacement. Methods Six electronic databases and 2 websites were searched. Two independent reviewers completed study inclusion, quality assessment, and data extraction. Data were iteratively synthesised using first-, second-, and third-order analyses. Results Twenty-eight studies were included. Four themes were identified; perceptions of pain and function were inseparable. Theme 1 addressed experiences of recovery after surgery, which often differed from expectations. Theme 2 described the challenges of the pain experience and its functional impact, including the difficulty navigating medication use in context of personal beliefs and perceived stigma. Theme 3 articulated the toll of ongoing problems spanning pain-function-mood, necessitating the need to "endure." Theme 4 encompassed the importance of clinical/social interactions on mood and pain, with reports of concerns dismissed and practical support missing. Conclusions Together, these findings show that numerous individual considerations beyond the technical aspects of surgery influence experiences of pain and function. A tailored approach addressing these considerations from the patient perspective could provide a basis for improved success of knee replacement surgery.
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Zhai K, Orr M, Grits D, Emara AK, Rothfusz CA, Piuzzi NS. Factors Affecting 30-Day Mortality following Primary Elective Total Knee Arthroplasty: A Database Study of 326,157 Patients. J Knee Surg 2021; 36:575-583. [PMID: 34921379 DOI: 10.1055/s-0041-1740386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite its rarity, the risk of mortality following primary elective total knee arthroplasty (TKA) is a critical component of surgical decision-making and patient counseling. The purpose of our study was to (1) determine the overall 30-day mortality rate for unilateral primary elective TKA patients, (2) determine the 30-day mortality rates when stratified by age, comorbidities, and preoperative diagnosis, and (3) identify the distribution of (i) patient demographics, (ii) baseline comorbidities, and (iii) preoperative diagnoses between mortality and mortality-free cohorts. A total of 326,157 patients underwent primary elective TKA (2011-2018) were identified through retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into 30-day mortality (n = 320) and mortality-free (n = 325,837) cohorts. Patient demographics, preoperative comorbidities, and preoperative diagnoses were compared. Age group, American Society of Anesthesiology (ASA) score, and modified Charlson Comorbidity Index (CCI) scores were normalized per 1000 and stratified by preoperative diagnosis. The overall mortality rate was 0.098%. Older age (p < 0.001) and male gender (p < 0.001) were associated with increased mortality. There was no association between mortality and race (p = 0.346) or body mass index (BMI) class (p = 0.722). All reported comorbidities except smoking status were significantly greater in the mortality cohort (p < 0.05). For ASA scores of I, II, III, and IV, the number of deaths per 1,000 were 0.16, 0.47, 1.4, and 4.4, respectively. For CCI scores of 0, 1, 2, 3, 4, and 6, mortality rates per 1,000 were 0.76, 2.1, 7.0, 11, 29, and 7.6, respectively. Mortality rates for a preoperative diagnosis of osteoarthritis (OA) versus non-OA were, respectively, 0.096% and 0.19% (p < 0.001). Increased age, male gender, increased comorbidity burden, and non-OA preoperative diagnoses are associated with higher rates of 30-day postoperative mortality. There were no significant associations between BMI or race and 30-day mortality. These findings aid in identifying of higher-risk patients, who can then receive appropriate counseling or preoperative interventions to reduce the risk of perioperative mortality.
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Affiliation(s)
- Kevin Zhai
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa Orr
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Grits
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Christopher A Rothfusz
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Rahimnia A, Alishiri G, Bayatpoor ME, Hosseini MA, Najafizadeh-Sari S, Yaribeygi H, Sahebkar A. Evaluation of Disease Severity and Health-Related Quality of Life in Patients with Rheumatoid Arthritis Undergoing Total Knee Arthroplasty. Curr Rheumatol Rev 2021; 17:88-94. [PMID: 32679019 DOI: 10.2174/1573397116666200717124621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 01/04/2023]
Abstract
;Background: The Total Knee Arthroplasty (TKA) is one of the most common surgical intervention in patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Previous studies suggested a significant improvement in health status after TKA surgery. But we have little data about the Iranian population undergone TKA. In the current clinical study, we evaluated postoperatively health status using reliable tools of MOS SF-36 and WOMAC in OA and RA patients undergoing TKA. METHODS In this cohort study, patients with OA and/or RA who were candidates for TKA surgery were included. Using two reliable questionnaires, i.e., WOMAC and SF-36, the quality of life of patients was examined during a period of six months (three monthly intervals) after the surgery. All data were analyzed using IBM SPSS Statistics. Kolmogrov-Smirnov, Kendall's tau, chi-square test and K-related Non-parametric tests were used. RESULTS Of the 2126 patients who underwent TKA, there were 2024 diagnosed osteoarthritis and 102 validated RA over one year. The mean ± SD of age and the average BMI were 68.0 ± 7.0 BMI 28.5 kg/m2, respectively. Regarding comorbidities and concurrent disorders, about 14% of cases were diabetic, 42% had cardiovascular diseases, 3% had respiratory diseases, and 12% involved with gastrointestinal diseases. The result of SF-36 dramatically increased during follow up. The central distributions of all domains in the SF-36 questionnaire indicated that most scores increased during the time after surgery. As a consequence, WOMAC and MOS FS-36 indicated statistically significant changes after TKA for those who are suffering from RA or OA. CONCLUSION TKA is an effective surgical process, which improves the quality of life in OA and/or RA. In addition, WOMAC and SF-36 examining tools are likely reliable tools with similar results to assess patients' quality of life after TKA surgery.
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Affiliation(s)
- Alireza Rahimnia
- Department of Orthopedic, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Alishiri
- Department of Rheumatology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad E Bayatpoor
- Student's Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad A Hosseini
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Habib Yaribeygi
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
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