Patients with rheumatoid arthritis are at increased risk for complications following knee and hip replacements: study

Patients with rheumatoid arthritis are at a higher risk for dislocation following total hip arthroplasty (THA) and infection following total knee arthroplasty (TKA) when compared to those with osteoarthritis according to new research by the Institute for Clinical Evaluative Sciences (ICES) and the University of Toronto.

Osteoarthritis, the most common form of arthritis, involves the wearing away of the cartilage that caps the bones in joints. Whereas rheumatoid arthritis, is an autoimmune disease in which the body's own immune system attacks the body's joints. Most of the evidence about complications following THA (also known as total hip replacement) and TKA (also known as total knee replacement) are based on patients with osteoarthritis.

The study, “Patients with rheumatoid arthritis are at increased risk for complications following total joint arthroplasty,” published today in Arthritis & Rheumatism, shows total joint arthroplasty (TJA) recipients with rheumatoid arthritis are younger, more likely to be female, have a higher burden of co-morbidities and greater prevalence of frailty.

“This study shows rheumatoid arthritis patients are more likely to experience complications because of the various medications they take, implant choice, post-operative antibiotic protocol and method of rehabilitation following joint replacement,” says Dr. Bheeshma Ravi, lead author and resident physician in U of T’s Division of Orthopedic Surgery. “Further research is crucial to shed light on these areas.

”Most of the evidence regarding complications following THA and total TKA are based on patients with osteoarthritis; less is known about outcomes in rheumatoid arthritis.

The large population cohort study found:

• TJA recipients with rheumatoid arthritis were approximately twice as likely to experience a dislocation following THA
• TJA recipients with rheumatoid arthritis were one-and-a-half times as likely to experience an infection following TKA, relative to recipients with osteoarthritis
• THA recipients with rheumatoid arthritis were also one-third as likely to experience a venous thromboembolism relative to those with osteoarthritis

The authors add both dislocation and infection lead to significant morbidity, and drastically increase healthcare costs. Research is warranted to explain this increased risk among patients with rheumatoid arthritis. This information will be valuable to inform patient management decisions, including the development and implementation of strategies designed to target modifiable risk factors.

Authors: Ravi B, Croxford R, Hollands S, Paterson MJ, Bogoch E, Kreder H, Hawker G.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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The University of Toronto Faculty of Medicine is at the heart of one of the great biomedical research, education and clinical care networks in the world. With nine fully affiliated hospitals and research institutes and 18 community-affiliated hospitals and clinical care sites, the Faculty of Medicine is a research powerhouse that offers unparalleled opportunities for its 6,800 faculty and 8,000-plus students at all levels. Nearly half of Ontario’s medical doctors and fully 25 per cent of all health and biomedical PhDs in Canada were trained by the Faculty of Medicine, which consistently ranks among the top medical schools worldwide.

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