New York—March 13, 2014
Generally, patients with an inflammatory systemic disease such as rheumatoid arthritis (RA) are sicker than patients with the degenerative condition osteoarthritis (OA) , says senior study author Mark Figgie, M.D., chief of the Surgical Arthritis Service at Hospital for Special Surgery, and the hospital’s first Allan E. Inglis, M.D., Chair in Surgical Arthritis.
RA patients are more likely to have conditions such as vasculitis or heart disease, and may be on medications that suppress the immune system, potentially making surgery more complicated. Many RA patients who need both knees replaced do so in separate surgeries, each replacing just one knee at a time.
In a new study, “Rheumatoid Arthritis Does Not Increase Perioperative Complications Following Same-day Bilateral TKA,” presented at the annual meeting of the American Academy of Orthopaedic Surgeons in New Orleans on March 13, Dr. Figgie and colleagues found that select patients with RA do just as well with same-day bilateral knee replacement as OA patients, and with no higher complication rate.
Dr. Figgie and colleagues analyzed hospital data from 240 RA patients and 3,680 OA patients who had bilateral knee replacement surgeries between 1998 and 2011. On average, the RA patients were about five years younger but were more likely to be obese or have significant heart disease. More than 80 percent of the RA patients were women.
The average hospital stay was slightly higher for RA patients, a difference of 5.8 days versus 5.4 days for the OA patients. The RA group was more likely to have acute postoperative anemia (17% versus 8% for OA patients) and blood transfusions (84% versus 77% for OA patients), but had similar rates of transfer to either the ICU or a rehabilitation facility. Researchers found no differences in the overall rates of procedure-related, minor and major complications between the two groups.
Rheumatoid arthritis patients should be carefully screened for surgery with stress tests, Dr. Figgie says. Although the bilateral procedure appears safe in RA patients without significant heart disease, he says, “These are typically more challenging cases, and surgeons will want to coordinate patient care with rheumatologists to avoid flares during the postoperative period.”
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.