In the first systemic review of evidence assessing complications
following total joint arthroplasty, patients with rheumatoid arthritis
(RA) were found to have an increased risk for hip dislocation after hip
replacement surgery compared to those with osteoarthritis (OA). Study
findings published online in Arthritis
& Rheumatism, a journal of the American College of
Rheumatology (ACR), also indicate that RA patients have a higher
infection risk following total knee replacement than patients with OA.
The ACR reports that OA—the most common form of arthritis—affects 27
million Americans 25 years of age and older, and another 1.3 million
adults are living with RA. Previous studies show that one of the most
effective treatment options for end-stage arthritis of the hip or knee
is total joint replacement. Experts suggest that success with this
intervention is evident given the increasing rates of joint
replacements. According to the Centers for Disease Control and
Prevention (CDC) 676,000 total knee replacements and 327,000 total hip
replacements were performed in the U.S. in 2009.
“Joint arthroplasty is successful in relieving the pain and disability
caused by hip or knee arthritis,” said lead author Dr. Bheeshma Ravi
from the University of Toronto and Women's College Research Institute
(WCRI) in Canada. “While complication rates are low there are some cases
with serious consequences that include infection, joint dislocation,
blood clots and even death.”
To explore this important issue, Dr. Ravi and colleagues conducted a
systemic review of the literature to assess complication risk in OA and
RA patients following joint replacement surgery. Evidence from January
1990 to December 2011 was evaluated and 40 studies were included in the
analysis. The study population included patients aged 18 years or older
who had hip or knee replacements and excluded patients who had
replacement surgery due to a fracture or cancer. Studies that involved
200 joints or more were incorporated in the current analysis.
Analysis shows RA patients had a higher risk of dislocation following
hip replacement surgery than patients with OA. RA patients who had total
knee replacements were also at higher risk of infection compared to
those with OA. The team found no difference in revision rate, 90-day
mortality or blood clot risk between the two patient groups. Dr. Ravi
concludes, “Additional studies to confirm our findings are necessary and
further investigation of possible reasons for differences in joint
replacement complication rates between RA and OA patients is needed.”
