Total Knee Arthroplasty Associated with Higher Risks in Inflammatory Arthritis

Mar 07, 2016

Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are linked with an increased risk of complications from total knee arthroplasty, AAOS 2016 study finds.

Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are linked with an increased risk of complications from total knee arthroplasty, new research finds.

Previous studies had found that complications, such as loosening of the prosthesis after a total knee arthroplasty, are more common in patients with osteoarthritis and rheumatoid arthritis than healthy controls. Complications in rheumatoid arthritis tend to be more serious than complications in osteoarthritis, likely because of factors like corticosteroid use, which may lead to a greater incidence of later infections, according to a 2012 review in the journal Knee Surgery and Related Research.

But less common inflammatory ailments, such as psoriatic arthritis and ankylosing spondylitis, had been understudied, University of Virginia School of Medicine orthopedic resident Jourdan Cancienne, MD., and colleagues reported on March 2 during the annual meeting of the American Academy of Orthopaedic Surgeons in Orlando, Florida. The researchers used a national database to compare cohorts of patients with rheumatoid arthritis (n=153,531), psoriatic arthritis (n=7,918), ankylosing spondylitis (4,575) and non-inflammatory arthritis (1,751,938) who underwent total knee replacements.[[{"type":"media","view_mode":"media_crop","fid":"46546","attributes":{"alt":"©Molekuul.be/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_8408092681784","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5409","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©Molekuul.be/Shutterstock.com","typeof":"foaf:Image"}}]]

The cohorts were similar in age and obesity rates, and all were made up of more women than men. The researchers compared rates of complications including postoperative deep-vein thrombosis, pulmonary embolism, infection and stiffness as well as 90-day readmission rate and revisions at one year and eight years post-operation. The results showed that all three types of inflammatory arthritis were associated with higher rates of infection, revision, systemic complications and 90-day readmission.

There were no differences between the different types of inflammatory arthritis in terms of systemic complications, local complications, readmission or revision, Dr. Cancienne and his colleagues found. Deep-vein thrombosis and pulmonary embolism were elevated in the postoperative rheumatoid arthritis patients, but not in the ankylosing spondylitis or psoriatic arthritis patients. Inflammatory arthritis was not linked with an increase in postoperative stiffness over non-inflammatory arthritis.

 

References:

“Complications after Total Knee Arthroplasty in Patients with Inflammatory Arthritis,” Jourdan Cancienne, MD., March 2, 2016, 2016 annual meeting of the American Academy of Orthopaedic Surgeons in Orlando, Florida.

Lee JK, Choi C-H. “Total Knee Arthroplasty in Rheumatoid Arthritis.” Knee Surgery & Related Research. 2012;24(1):1-6.