title: Patients with rheumatoid arthritis are more likely to have pain and poor function after total hip replacements than patients with osteoarthritis.
abstract: OBJECTIVE
  Total hip replacement (THR) outcomes have been worse for patients with rheumatoid arthritis (RA) compared with those who have osteoarthritis (OA). Whether this remains true in contemporary patients with RA with a high use of disease-modifying and biologic therapy is unknown. The purpose of our study is to assess pain, function, and quality of life 2 years after primary THR, comparing patients with RA and patients with OA.
  
  
  METHODS
  Baseline and 2-year data were compared between validated patients with RA and patients with OA who were enrolled in a single-center THR registry between May 1, 2007, and February 25, 2011.
  
  
  RESULTS
  There were 5666 eligible primary THR identified, of which 193 were for RA. RA THR had worse baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain (44.8 vs 53.2, p < 0.001) and function (38.7 vs 49.9, p < 0.001) compared with OA. These differences remained after surgery: pain (88.4 vs 94.0, p < 0.001) and function (82.9 vs 91.8, p < 0.001). Patients with RA were as likely to have a significant improvement as patients with OA (Δ WOMAC > 10) in pain (94% vs 96%, p = 0.35) and function (95% vs 94%, p = 0.69), but were 4 times as likely to have worse function (WOMAC ≤ 60; 19% vs 4%, p < 0.001) and pain (12% vs 3%, p < 0.001). In multivariate logistic regression controlling for multiple potential confounders, RA increased the odds of poor postoperative function (OR 4.32, 95% CI 1.57-11.9), and in patients without a previous primary THR, worse postoperative pain (OR 3.17, 95% CI 1.06-9.53).
  
  
  CONCLUSIONS
  Contemporary patients with RA have significant improvements in pain and function after THR, but higher proportions have worse 2-year pain and function. In addition, RA is an independent predictor of 2-year pain and poor function after THR, despite high use of disease-modifying therapy.
authors.affiliation: From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery. GoodmanS@HSS.edu.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Goodman
authors.affiliation: From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Ramsden-Stein
authors.affiliation: From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery.
authors.forename: Wei-Ti
authors.initials: WT
authors.lastname: Huang
authors.affiliation: From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhu
authors.affiliation: From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Figgie
authors.affiliation: From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Alexiades
authors.affiliation: From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mandl
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology*; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology*; D012042:Registries; D016896:Treatment Outcome
keywords: ARTHROPLASTY; OSTEOARTHRITIS; OUTCOME MEASURES; RHEUMATOID ARTHRITIS