LoVerde Zachary J, Mandl Lisa A, Johnson Beverly K, Figgie Mark P, Boettner Friedrich, Lee Yuo-Yu, Goodman Susan M
From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
J Rheumatol. 2015 Jul;42(7):1123-30. doi: 10.3899/jrheum.141251. Epub 2015 May 1.
More adverse events (AE) are reported after total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA) than for patients with osteoarthritis (OA). This study evaluates 6-month postoperative AE in a high-volume center in a contemporary RA cohort.
Patients with RA in an institutional registry (2007-2010) were studied. AE were identified by self-report and review of office and hospital charts. Subjects with RA were matched to 2 with OA by age, sex, and procedure. RA-specific surgical volume was determined. Baseline characteristics and AE were compared and analyzed.
There were 159 RA TKA and 318 OA. Of the patients with RA, 88.0% were women, 24.5% received corticosteroids, 41.5% received biologics, and 67% received nonbiologic disease-modifying antirheumatic drugs (DMARD). There was no difference in comorbidities. RA-specific surgical volume was high; 64% of cases were performed by surgeons with ≥ 20 RA cases during the study period. Patients with RA had worse baseline pain and function and lower perceived health status (EQ-5D 0.59 vs 0.65, p < 0.01). There were no deep infections in either group and no difference in superficial infection (9.4% RA vs 10.1% OA, p = 0.82), myocardial infarction (0.7% RA vs 0% OA, p = 0.33), or thromboembolism (1.3% RA vs 0.6% OA, p = 0.60).
In a high-volume center, with high RA-specific experience, RA does not increase postoperative AE. Despite worse preoperative function and high steroid and DMARD use, complications were not increased. However, further study to determine generalizability is needed.
与骨关节炎（OA）患者相比，类风湿关节炎（RA）患者全膝关节置换术（TKA）后报告的不良事件（AE）更多。本研究评估了当代RA队列中一个高手术量中心术后6个月的AE情况。
对机构登记处（2007 - 2010年）的RA患者进行研究。通过自我报告以及查阅门诊和医院病历确定AE。将RA患者按年龄、性别和手术方式与2名OA患者进行匹配。确定RA特异性手术量。比较并分析基线特征和AE。
有159例RA患者接受TKA，318例OA患者接受TKA。RA患者中，88.0%为女性，24.5%接受皮质类固醇治疗，41.5%接受生物制剂治疗，67%接受非生物改善病情抗风湿药物（DMARD）。合并症方面无差异。RA特异性手术量较高；64%的病例由在研究期间完成≥20例RA手术的外科医生进行。RA患者的基线疼痛和功能更差，健康状况感知更低（EQ - 5D评分0.59对0.65，p < 0.01）。两组均无深部感染，浅表感染（RA组9.4%对OA组10.1%，p = 0.82）、心肌梗死（RA组0.7%对OA组0%，p = 0.33）或血栓栓塞（RA组1.3%对OA组0.6%，p = 0.60）方面也无差异。
在一个具有高RA特异性经验的高手术量中心，RA不会增加术后AE。尽管术前功能较差且大量使用类固醇和DMARD，但并发症并未增加。然而，需要进一步研究以确定其普遍性。
