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Thirty-day complications in rheumatoid patients following total knee arthroplasty

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Abstract

Although total knee arthroplasty (TKA) is highly successful for patients with end-stage rheumatoid arthritis (RA), the risks and complications associated with surgery in this cohort are less defined. The objectives of our study were to analyze the demographic and perioperative factors of RA patients that may affect post-TKA outcomes, as well as to assess the 30-day complication rates compared to osteoarthritis patients. We retrospectively evaluated the National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2012 to assess all patients who underwent a primary TKA and had a diagnosis of rheumatoid arthritis (n = 141) or primary knee osteoarthritis (n = 7125). We evaluated and compared the demographic factors, social factors, preoperative factors, operative factors, and postoperative complications. The RA cohort had a lower mean age and body mass index than patients in the OA group. There was also a significantly higher incidence of women and Hispanics in the RA cohort. There was a lower incidence of diabetes and hypertension requiring medication in the rheumatoid cohort, but also a higher incidence of bleeding disorders. The RA cohort had an increased proportion of patients requiring blood transfusions and had a longer mean length of stay. The incidence of pneumonia and postoperative bleeding that required transfusion was also higher in RA patients. Rheumatoid patients had higher rates of wound infections, pulmonary embolisms, and deep vein thrombosis; however, these findings were not significant. Although RA patients with end-stage knee arthritis may benefit from TKA, these patients should be preoperatively optimized to minimize complication risks.

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Funding

This study was performed without external funding.

Disclosures

Julio J. Jauregui, nothing to disclose

Bhaveen H. Kapadia, consultant for SAGE Inc.

Anant Dixit, nothing to disclose

Qais Naziri, nothing to disclose

Jules D. Hip-Flores, nothing to disclose

Steven F. Harwin reports grants and personal fees from SLACK Incorporated. He is a paid consultant for Stryker, Convatec. He receives royalties from Thieme, Inc. and Journal of Knee Surgery and is on the Editorial board of Journal of Arthroplasty, Orthopedics, Journal of Knee Surgery, and Surgical Technology International.

Michael A. Mont receives royalties from Stryker and Microport. He is a paid consultant for Biocomposites; DJ Orthopaedics; Joint Active Systems; Medtronic; Sage Products, Inc.; Stryker; TissueGene; and Microport. He receives research support from DJ Orthopaedics; Joint Active Systems; National Institutes of Health (NIAMS & NICHD); Sage Products, Inc.; Stryker; Tissue Gene; and Microport. He is on the editorial board of the American Journal of Orthopedics; Journal of Arthroplasty; Journal of Bone and Joint Surgery – American; Journal of Knee Surgery; Surgical Techniques International. He is a board member of the American Academy of Orthopaedic Surgeons.

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Authors and Affiliations

  1. Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Julio J. Jauregui & Michael A. Mont

  2. SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA

    Bhaveen H. Kapadia, Anant Dixit, Qais Naziri & David J. Hip-Flores

  3. Beth Israel Medical Center, Adult Reconstruction and Total Joint Replacement Service, New York, NY, USA

    Steven F. Harwin

Authors
  1. Julio J. Jauregui
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  2. Bhaveen H. Kapadia
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  3. Anant Dixit
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  4. Qais Naziri
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  5. David J. Hip-Flores
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  6. Steven F. Harwin
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  7. Michael A. Mont
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Correspondence to Michael A. Mont.

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Jauregui, J.J., Kapadia, B.H., Dixit, A. et al. Thirty-day complications in rheumatoid patients following total knee arthroplasty. Clin Rheumatol 35, 595–600 (2016). https://doi.org/10.1007/s10067-015-3037-4

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  • DOI: https://doi.org/10.1007/s10067-015-3037-4

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