Rheumatoid Arthritis vs Osteoarthritis: Comparison of Demographics and Trends of Joint Replacement Data from the Nationwide Inpatient Sample

Aug 4, 2018American journal of orthopedics (Belle Mead, N.J.)

Differences in patient characteristics and joint replacement trends between rheumatoid arthritis and osteoarthritis

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Abstract

RA patients face a higher risk of postoperative complications than OA patients following total knee or hip arthroplasty.

Osteoarthritic patients undergoing total hip arthroplasty (THA) have a lower risk of cardiovascular, pulmonary, wound dehiscence, infections, and systemic complications compared to rheumatoid arthritis (RA) patients.
THA candidates with osteoarthritis showed a significantly elevated risk of cerebrovascular complications compared to RA candidates.
Osteoarthritic patients undergoing total knee arthroplasty (TKA) experienced higher rates of cardiovascular and cerebrovascular complications.
Mechanical wound complications, infections, and systemic complications were significantly reduced in osteoarthritic TKA patients.
Overall, RA patients are associated with increased postoperative risks, indicating the need for enhanced preoperative management to improve outcomes.

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Current literature regarding complications following total joint arthroplasty have primarily focused on patients with osteoarthritis (OA), with less emphasis on the trends and in-hospital outcomes of rheumatoid arthritis (RA) patients undergoing these procedures. The purpose of this study is to analyze the outcomes and trends of RA patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) compared to OA patients. Data from the Nationwide Inpatient Sample from 2006 to 2011 was extracted using the International Classification of Diseases, Ninth Revision codes for patients that received a TKA or THA. Outcome measures included cardiovascular complications, cerebrovascular complications, pulmonary complications, wound dehiscence, and infection. Inpatient and hospital demographics including primary diagnosis, age, gender, primary payer, hospital teaching status, Charlson Comorbidity Index score, hospital bed size, location, and median household income were analyzed. Logistic regression analysis of OA vs RA patients with patient outcomes revealed that osteoarthritic THA candidates had lower risk for cardiovascular complications, pulmonary complications, wound dehiscence, infections, and systemic complications, compared to rheumatoid patients. There was a significantly elevated risk of cerebrovascular complication in osteoarthritic THA compared to RA THA. OA patients undergoing TKA had significantly higher risk for cardiovascular and cerebrovascular complications. There were significant decreases in mechanical wounds, infection, and systemic complications in the OA TKA patients. RA patients are at higher risk for postoperative infection, wound dehiscence, and systemic complications after TKA and THA compared to OA patients. These findings highlight the importance of preoperative medical clearance and management to optimize RA patients and improve the postoperative outcomes.

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Rheumatoid Arthritis vs Osteoarthritis: Comparison of Demographics and Trends of Joint Replacement Data from the Nationwide Inpatient Sample

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