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Studies: Patients with RA benefit from joint replacement procedures

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Two studies from the European League Against Rheumatism Annual Congress indicate patients with rheumatoid arthritis who undergo total joint replacement stand to benefit from the procedure as much as patients with osteoarthritis.

“When we looked at function using the WOMAC scale, function was significantly worse in the rheumatoid arthritis patients prior to surgery, but interestingly, when we looked at how they did 2 years down the road, they were as likely to have an improvement in function and pain,” Susan Goodman, MD, from Hospital for Special Surgery, stated in a press release of the patients who underwent total hip replacement (THR).

 

Susan Goodman

Since 2007, Goodman and colleagues have prospectively evaluated THR and total knee replacement (TKR) patients with either rheumatoid arthritis (RA) or osteoarthritis (OA) in their institution’s joint replacement registry. They identified 6,012 primary THR (202 RA, 5,810 OA) and 503 revision THR (58 RA, 445 OA) patients who had similar WOMAC outcomes. They found that 92% of RA patients had a greater than 10 point WOMAC score increase compared to 96% of OA patients at 2 years, which was a significant improvement. A significant improvement in WOMAC scores in revision THR patients were seen in 88% of patients with RA and 72% of patients with OA.

Goodman suggested primary THR patients with RA may have been delaying their surgery, causing worse outcomes than patients with OA.

“The [RA] patients have a great response in terms of hip replacement and their hip function improved,” Goodman said. “Nonetheless, they were a group that did not do as well.”

For patients with RA who underwent total knee replacement, Goodman and colleagues reviewed 5,384 primary TKR (178 RA, 5,206 OA) and 374 revision TKR (32 RA, 342 OA) patients. She said the patients with RA had significantly lower preoperative scores but caught up to the OA control group, having no significant difference in function or pain at 2-year follow-up.

The researchers found 92% and 89% of RA and OA patients, respectively, had a significant improvement in WOMAC scores. In 89% of revision TKR patients with RA, there was a significant improvement in WOMAC scores, while 73% of revision TKR patients with OA had significant improvement, according to the release.

Reference:

Goodman SM. Rheumatoid arthritis patients have worst outcomes after total hip replacements compared with osteoarthritis patients. Presented at: European League Against Rheumatism Annual Congress. June 12-15, 2013; Madrid.

Goodman SM. Rheumatoid arthritis (RA) patients have similar excellent outcomes after total knee replacement compared with osteoarthritis (OA) patients. Presented at: European League Against Rheumatism Annual Congress. June 12-15, 2013; Madrid.

Disclosure: The authors have no relevant financial disclosures.