Dr. Ravi emphasizes that the findings of the study remained consistent in various sensitivity analyses conducted in the study. He also emphasizes that, despite the small sample size that limited the ability to stratify the study by age or gender, the results of a subgroup analysis performed in persons with at least one risk factor for cardiovascular disease (other than OA) were consistent with the results of the main analysis.
Commenting on the study, Elaine Husni, MD, MPH, director of the Arthritis & Musculoskeletal Center, Cleveland Clinic, Cleveland, said the findings of the study provide a good message to patients with OA who need a TJA that there may be a possible added value to the surgery associated with reduced cardiovascular morbidity. However, she cautions that as a population-based retrospective review, only associations can be made based on the data.
“I am not sure this changes my clinical practice in terms of a decision to have surgery, which is still based on the severity of the OA disease, patient symptoms and functional ability,” she says.
As we become more sophisticated in total joint arthroplasty, our patients with RA may, if appropriately screened, benefit from same-day bilateral total joint surgeries similar to patients with OA.
Same-Day Bilateral Knee Replacement in Patients with RA
In a second study, investigators from the Hospital for Special Surgery in New York found that patients with RA who underwent same-day bilateral knee replacement had no significant differences in minor or major complications or 30-day mortality compared with patients with OA who underwent the same procedure.
“What the study showed is that in carefully selected, well-managed patients with rheumatoid arthritis, we can successfully do bilateral knee replacements,” says Mark P. Figgie, MD, chief of the Surgical Arthritis Service, Allan E. Inglis, MD Chair in Surgical Arthritis, Hospital for Special Surgery, New York, adding that these patients did relatively well even though they had a slightly higher rate of comorbidities than the patients with OA.
In the retrospective study, Dr. Figgie and colleagues compared 30-day mortality rates of in-hospital complications and risk for major morbidity or mortality between 240 patients with RA and 3,680 patients with OA who underwent same-day bilateral total knee arthroplasty between 1998 and 2011 at their high-volume institution. Compared with the patients with OA, more of the RA patients were younger, were female and had a higher rate of overall comorbidities.
The study found no difference in 30-day mortality between patients with RA and those with OA (5.8 vs. 5.4 days, P=0.007), nor in rates of procedure-related complications (2.2% vs. 1.7%, P=0.644) that were major (6.2% vs. 5.2%, P=0.463) or minor (23.7% vs. 26.6%, P=0.327).
