title: Patients with Rheumatoid Arthritis have Similar Excellent Outcomes after Total Knee Replacement Compared with Patients with Osteoarthritis.
abstract: OBJECTIVE
  Although new treatments for rheumatoid arthritis (RA) are extremely effective in preventing disease progression, rates of total knee replacement (TKR) continue to rise. The ongoing need for TKR is problematic, especially as functional outcomes in patients with RA have been reported to be worse than in patients with osteoarthritis (OA). The purpose of this study is to assess pain, function, and quality of life 2 years after TKR in contemporary patients with RA compared with patients with OA.
  
  
  METHODS
  Primary TKR cases enrolled between May 1, 2007 and July 1, 2010 in a single institution TKR registry were eligible for this study. Validated RA cases were compared with OA at baseline and at 2 years.
  
  
  RESULTS
  We identified 4456 eligible TKR, including 136 RA. Compared with OA, RA TKR had significantly worse preoperative Western Ontario and McMaster Universities Osteoarthritis Index pain (55.9 vs 46.6, p < 0.0001) and function (58.7 vs 47.3, p < 0.0001); however, there were no differences at 2 years. Within RA, there was no difference for patients who were treated with biologic disease-modifying antirheumatic drugs versus those who did not in pain (p = 0.41) or function (p = 0.39) at 2 years. In a multivariate regression, controlling for multiple potential confounders, there was no independent association of RA with 2-year pain (p = 0.18) or function (p = 0.71). Satisfaction was high for both RA and OA.
  
  
  CONCLUSIONS
  Patients with RA undergoing primary TKR have excellent 2-year outcomes, comparable with OA, in spite of worse preoperative pain and function. In this contemporary cohort, RA is not an independent risk factor for poor outcomes.
authors.affiliation: From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of 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, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
authors.forename: Beverly
authors.initials: B
authors.lastname: Johnson
authors.affiliation: From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
authors.forename: Meng
authors.initials: M
authors.lastname: Zhang
authors.affiliation: From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
authors.forename: Wei-Ti
authors.initials: WT
authors.lastname: Huang
authors.affiliation: From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhu
authors.affiliation: From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
authors.forename: Mark
authors.initials: M
authors.lastname: Figgie
authors.affiliation: From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
authors.forename: Michael
authors.initials: M
authors.lastname: Alexiades
authors.affiliation: From the Division of Rheumatology, Weill Cornell Medical School, and Department of Medicine, and Department of Orthopedic Surgery, and Department of Biostatistics Core, Hospital for Special Surgery; Albert Einstein College of Medicine; Jacobi Medical Center, New York; North Central Bronx Hospital, Bronx, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Department of 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 North Central Bronx Hospital; M. Zhang, PhD, Biostatistician, Hospital for Special Surgery; W.T. Huang, MS, Biostatistician, Hospital for Special Surgery; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service, Hospital for Special Surgery; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Weill Cornell Medicine College, and Associate Attending Physician, Hospital for Special Surgery; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Department of Rheumatology, Hospital for Special Surgery.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mandl
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000534:rehabilitation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000534:rehabilitation; D011182:Postoperative Care; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ARTHROPLASTY; DISEASE-MODIFYING ANTIRHEUMATIC DRUGS; OSTEOARTHRITIS; RHEUMATOID ARTHRITIS