Knee Replacement Offers Cardiovascular Benefits for Patients with Arthritis

Compared with patients with OA, patients with RA were more likely to have acute anemia after surgery (8.1% vs. 17.1%, P<0.0001) and need blood transfusions (76.5% vs. 84.2%, P=0.008); however, there was no difference between the two groups in transfer to an intensive care unit (0.7% vs. 0.8%, P=0.2) and rehabilitation (72% vs. 77%, P=0.2).

According to Dr. Figgie, the similar morbidity and mortality rates between the two groups were somewhat surprising because he and his colleagues anticipated that the RA patients would not do as well.

Importantly, he says, the RA patients selected to undergo bilateral knee replacement in the study underwent the same medical criteria used to assess the eligibility for this procedure in patients with OA. These criteria include age (procedure is not even considered in patients older than 80 years), screening for cardiovascular issues and uncontrolled diabetes.

Because patients with RA often present with complex medical and orthopedic issues, same-day bilateral knee replacement can be challenging for surgeons. Dr. Figgie emphasized that the study shows this procedure is safe in patients with RA, particularly when done in high-volume institutions that provide comprehensive care for the RA patients.

Recent data, he says, indicate that surgeons who have a high volume of RA patients tend to have better outcomes with joint replacement in these patients compared to surgeons who do a high volume of joint replacements but who do not treat many RA patients.¹

For Dr. Husni, the study highlights that RA patients are most likely benefiting from the advances of RA treatment that permit more stable disease and subsequently may put them less at risk if they do need surgery. “This is promising news,” she said, “that 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 osteoarthritis.”

Mary Beth Nierengarten is a freelance medical journalist based in St. Paul, Minn.

Reference

1. Ravi B, Croxford R, Austin PC, et al. Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty. Arthritis Rheumatol. 2014 Mar;66(3):488–496.