Rheumatoid Arthritis Does Not Increase Risk of Short-term Adverse Events after Total Knee Arthroplasty: A Retrospective Case-control Study.
OBJECTIVE
More adverse events (AE) are reported after total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA) than for patients with osteoarthritis (OA). This study evaluates 6-month postoperative AE in a high-volume center in a contemporary RA cohort.


METHODS
Patients with RA in an institutional registry (2007-2010) were studied. AE were identified by self-report and review of office and hospital charts. Subjects with RA were matched to 2 with OA by age, sex, and procedure. RA-specific surgical volume was determined. Baseline characteristics and AE were compared and analyzed.


RESULTS
There were 159 RA TKA and 318 OA. Of the patients with RA, 88.0% were women, 24.5% received corticosteroids, 41.5% received biologics, and 67% received nonbiologic disease-modifying antirheumatic drugs (DMARD). There was no difference in comorbidities. RA-specific surgical volume was high; 64% of cases were performed by surgeons with ≥ 20 RA cases during the study period. Patients with RA had worse baseline pain and function and lower perceived health status (EQ-5D 0.59 vs 0.65, p < 0.01). There were no deep infections in either group and no difference in superficial infection (9.4% RA vs 10.1% OA, p = 0.82), myocardial infarction (0.7% RA vs 0% OA, p = 0.33), or thromboembolism (1.3% RA vs 0.6% OA, p = 0.60).


CONCLUSIONS
In a high-volume center, with high RA-specific experience, RA does not increase postoperative AE. Despite worse preoperative function and high steroid and DMARD use, complications were not increased. However, further study to determine generalizability is needed.
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
Zachary J
ZJ
LoVerde
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
Lisa A
LA
Mandl
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
Beverly K
BK
Johnson
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
Mark P
MP
Figgie
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
Friedrich
F
Boettner
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
Yuo-Yu
YY
Lee
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery. goodmans@hss.edu.
Susan M
SM
Goodman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D018501:Antirheumatic Agents
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; KNEE; OSTEOARTHRITIS; RHEUMATOID ARTHRITIS; SURGERY