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The Use of Biologic DMARDS Identifies Rheumatoid Arthritis Patients with More Optimistic Expectations of Total Knee Arthroplasty

  • Original Article
  • Published:
HSS Journal ®

Abstract

Background

Preoperative expectations of total knee arthroplasty (TKA) correlate with postsurgical satisfaction, and are linked to outcomes. Rheumatoid arthritis (RA), and other chronic diseases, may lower expectations, although new biologic medications have greatly enhanced patients’ quality of life.

Questions/Purposes

The purpose of this study is to compare preoperative expectations of RA to those of matched osteoarthritis (OA) patients undergoing TKA, and examine the subset of RA on biologic DMARD therapy.

Methods

For a cross-sectional study, RA and OA identified from an institutional TKA registry were matched on age, sex, prior TKA, and preoperative function. Expectations were measured using the Hospital for Special Surgery (HSS) Knee Expectations Survey. Expectations and quality of life measures were assessed preoperatively and scores were compared between RA and OA.

Results

One hundred fourteen RA cases, 46.5% on biologics, were matched to 228 OA cases. The average expectations score was not significantly lower for RA compared to OA (72.9 ± 20.7 vs. 77.2 ± 18.3, p = 0.040. RA on biologics had expectations similar to OA (total expectation score 76.3 ± 18.1 vs. 77.4 ± 17.4, p = 0.71), while RA not on biologics had expectations that were significantly lower (69.9 ± 22.4 vs. 77.1 ± 19.0, p = 0.03).

Conclusion

Use of biologics in RA patients was associated with higher expectations, similar to those of OA patients, but the effect on outcomes is not known. Further studies should assess the effect of higher expectations in RA patients on outcomes.

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Acknowledgments

Funding for this research came from AHRQ CERT GRANT: U18 HS016075, Hospital for Special Surgery Departments of Orthopedic ARJR Pilot Grant, Cornell CTSC GRANT UL1-RR024996, and National Institutes of Health Career Development Grant [R00 HD060686]. The funding agencies had no influence into the study design, results, or content of the manuscript.

Disclosures

ᅟ

Conflict of Interest:

Michael Alexiades, MD, Mark Figgie, MD, Susan M Goodman, MD, Lisa A. Mandl MD, MPH have declared that they have no conflict of interest. Hassan Ghomrawi, PhD, MPH reports grants from Agency for Health Care Research and Quality during the conduct of the study; grants from Mako Surgical, outside the work. Beverly K Johnson, MD, MS, reports stock in Johnson and Johnson, outside the work.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

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Disclosure forms provided by the authors are available with the online version of this article.

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Authors and Affiliations

  1. Division of Rheumatology, Weill Cornell Medical College, New York, NY, 10065, USA

    Susan M. Goodman MD, Lisa A. Mandl MD, MPH & Beverly K. Johnson MD, MS

  2. Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Susan M. Goodman MD, Lisa A. Mandl MD, MPH & Beverly K. Johnson MD, MS

  3. Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, 10065, USA

    Mark Figgie MD & Michael Alexiades MD

  4. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA

    Mark Figgie MD & Michael Alexiades MD

  5. Division of Health Policy, Weill Cornell Medical College, New York, NY, USA

    Hassan Ghomrawi PhD, MPH

  6. Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA

    Hassan Ghomrawi PhD, MPH

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  1. Susan M. Goodman MD
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  2. Lisa A. Mandl MD, MPH
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  3. Mark Figgie MD
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  4. Beverly K. Johnson MD, MS
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  5. Michael Alexiades MD
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  6. Hassan Ghomrawi PhD, MPH
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Correspondence to Susan M. Goodman MD.

Additional information

Level of Evidence: Prognostic Study: Level III. See levels of evidence for a complete description.

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Goodman, S.M., Mandl, L.A., Figgie, M. et al. The Use of Biologic DMARDS Identifies Rheumatoid Arthritis Patients with More Optimistic Expectations of Total Knee Arthroplasty. HSS Jrnl 10, 117–123 (2014). https://doi.org/10.1007/s11420-014-9380-1

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  • DOI: https://doi.org/10.1007/s11420-014-9380-1

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