Worse Outcomes for Total Joint Arthroplasty in RA vs. OA
Worse Outcomes for Total Joint Arthroplasty in RA Versus OA
(HealthDay News) – Patients with rheumatoid arthritis (RA) are at higher risk of dislocation and infection following total joint arthroplasty compared to patients with osteoarthritis (OA), according to a review published in the December issue of Arthritis & Rheumatism.
Bheeshma Ravi, MD, from the University of Toronto, and colleagues conducted a literature review of studies involving primary total joint arthroplasty of the hip (THA) or knee (TKA) which included information on outcomes in at least 200 RA and OA joints. Meta–analysis was performed when appropriate, or the level of evidence was assessed qualitatively.
The researchers found that, based on 40 studies, patients with RA were at increased risk of dislocation following THA (adjusted odds ratio, 2.16). Following TKA, fair evidence indicated an increased risk of infection and early revision in RA vs. OA. For patients with RA vs.OA, at later time points there was no evidence of any differences in rates of revision, 90–day mortality, or rates of venous thromboembolic events following THA or TKA. Only three studies explicitly defined RA (7.5%), and adjustment for covariates was included in 11 of the studies (27.5%).
"Adequately powered studies, which incorporate validated definitions for RA and OA diagnosis and control for appropriate confounders and other covariates, are needed to confirm these findings," Ravi and colleagues conclude.
One author disclosed financial ties to the pharmaceutical industry.