Background: Total joint arthroplasty (TJA) is indicated in persons with end-stage arthritis of the hip and knee (THA and TKA, respectively). While most TJAs are performed for osteoarthritis (OA), 3%-13% are performed in patients with rheumatoid arthritis (RA). Most of the evidence regarding complications following TJA is based on studies of patients with OA, with little known about recipients with RA. The purpose of this thesis was to summarize current evidence on the rates of complications following TJA in patients with RA, to quantify this risk using validated methods, and to determine the impact of surgeon experience performing TJA in persons with RA on this risk.
Methods: For reports published between 1990 and 2011, we evaluated the evidence regarding the risk of complications following TJA in RA using qualitative and quantitative methods. In a cohort of recipients of primary elective THA or TKA between 2002 and 2009, in Ontario, Canada, we identified patients with RA using a validated algorithm. Multivariable Cox proportional hazards regression was used to evaluate the relationship between arthritis type (RA, OA, other) and the occurrence of surgical complications, and to evaluate the impact of surgeon experience on the risk of a complication.
Results: Forty published studies were reviewed. Relative to TJA recipients with OA, those with RA were at increased risk of dislocation following THA, and increased risk for joint infection following TKA. These findings were confirmed in our cohort study: adjusted hazard ratio (HR) for dislocation 1.91, p=0.001; adjusted HR for infection 1.47, p=0.03). In TJA recipients with RA, greater surgeon RA volume was associated with a reduced risk for surgical complications (adjusted HR per 10 additional cases: 0.81, p=0.002).
Conclusions: In a population-based cohort of primary elective TJA recipients, patients with RA were at significantly increased risk for dislocation following THA and joint infection following TKA. Increased surgeon experience performing TJA in patients with RA attenuated the risk for surgical complications among TJA recipients with RA. Further research is required to identify the mediators of the increased complication risk in patients with RA, and to delineate strategies to optimize outcomes in these patients.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/43712 |
| Date | 14 January 2014 |
| Creators | Ravi, Bheeshma |
| Contributors | Hawker, Gillian |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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