A systematic review and meta‐analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis

Abstract

Objective. 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.Methods. 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, metaanalysis was performed; if this was not possible, the level of evidence was assessed qualitatively.Results. 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).Conclusion. 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.

Does Operative Time Affect Infection Rate in Primary Total Knee Arthroplasty?

“…Apart from operative time, other surgeon-related factors associated with PJI after TKA include surgeon case volume [14] and use of antibioticimpregnated cement [20]. Reported patient factors include male sex [13], preoperative comorbidities [13], diabetes mellitus [17], obesity [10,15,28], rheumatoid arthritis [26], and previous fractures about the knee [9]. Previously, the 75 th percentile of duration of the operation has been used to delineate between operations of short and long duration [4].…”

Primary total hip arthroplasty: health related quality of life outcomes

“…There are many unclear views about THA-related health outcomes with respect to socio-economic value [11][12][13][14], medical characteristics of patients [15], hospital volume [16,17], type of rehabilitation [18], etc. In addition to professional discrepancies towards these aspects, orthopaedic surgical practice is also not consensual on the choice of endoprosthetic fixation or the surgical access to hip [19,20].…”

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

“…We performed a systematic review and metaanalysis to examine TJA complication rates for patients with RA and those with OA (15). We found evidence of an increased risk of hip dislocation following THA and an increased risk of infection following TKA in patients with RA.…”