The Use of Biologic DMARDS Identifies Rheumatoid Arthritis Patients with More Optimistic Expectations of Total Knee Arthroplasty

HSS Journal: Volume 10, Issue 2

Susan M. Goodman, MD
Susan M. Goodman, MD
Associate Attending Physician, Hospital for Special Surgery
Associate Professor of Medicine, Weill Cornell Medical College
Lisa A. Mandl, MD, MPH
Lisa A. Mandl, MD, MPH
Assistant Attending Physician, Hospital for Special Surgery
Assistant Research Professor of Medicine, Weill Cornell Medical College
Assistant Research Professor of Public Health, Weill Cornell Medical College
Mark P. Figgie, MD
Mark P. Figgie, MD

Chief of the Surgical Arthritis Service, Hospital for Special Surgery
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery

Beverly K. Johnson MD, MS

Department of Rheumatology, Weill Cornell Medical College
Department of Rheumatology, Hospital for Special Surgery

Michael Alexiades MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Assistant Clinical Professor, Weill Cornell Medical College

Hassan Ghomrawi PhD, MPH

Division of Health Policy, Weill Cornell Medical College



Preoperative expectations of total knee arthroplasty (TKA) correlate with postsurgical satisfaction, and are linked to outcomes. Rheumatoid arthritis (RA), and other chronic diseases, may lower expectations, although new biologic medications have greatly enhanced patients’ quality of life.


The purpose of this study is to compare preoperative expectations of RA to those of matched osteoarthritis (OA) patients undergoing TKA, and examine the subset of RA on biologic DMARD therapy.


For a cross-sectional study, RA and OA identified from an institutional TKA registry were matched on age, sex, prior TKA, and preoperative function. Expectations were measured using the Hospital for Special Surgery (HSS) Knee Expectations Survey. Expectations and quality of life measures were assessed preoperatively and scores were compared between RA and OA.


One hundred fourteen RA cases, 46.5% on biologics, were matched to 228 OA cases. The average expectations score was not significantly lower for RA compared to OA (72.9 ± 20.7 vs. 77.2 ± 18.3, p = 0.040. RA on biologics had expectations similar to OA (total expectation score 76.3 ± 8.1 vs. 77.4 ± 17.4, p = 0.71), while RA not on biologics had expectations that were significantly lower (69.9 ± 22.4 vs. 77.1 ± 19.0, p = 0.03).


Use of biologics in RA patients was associated with higher expectations, similar to those of OA patients, but the effect on outcomes is not known. Further studies should assess the effect of higher expectations in RA patients on outcomes.

Level of Evidence: Prognostic Study: Level III. See levels of evidence for a complete description. 

This article appears in HSS Journal: Volume 10, Issue 2
View the full HSS Journal Online First article at

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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