The Use of Biologic DMARDS Identifies Rheumatoid Arthritis Patients with More Optimistic Expectations of Total Knee Arthroplasty
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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.
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.
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.
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).
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.
Keywordsexpectations arthroplasty rheumatoid arthritis osteoarthritis
- 16.Mahomed NN, Liang MH, Cook EF, et al. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol. 2002; 6: 1273-1279.Google Scholar
- 20.Mancuso CA, Sculco TP, Wickiewicz TL, et al. Patients’ expectations of knee surgery. J Bone Joint Surg Am. 2001; 7: 1005-1012.Google Scholar
- 22.Massardo L, Gabriel SE, Crowson CS, et al. A population-based assessment of the use of orthopedic surgery in patients with rheumatoid arthritis. J Rheumatol. 2002; 1: 52-56.Google Scholar
- 27.Poultsides LA, Ghomrawi HM, Lyman S, Aharonoff GB, Mancuso CA, Sculco TP. Change in preoperative expectations in patients undergoing staged bilateral primary total knee or total hip arthroplasty. J Arthroplasty. 2012.Google Scholar
- 31.Strand V, Singh JA. Improved health-related quality of life with effective disease-modifying antirheumatic drugs: Evidence from randomized controlled trials. Am J Manag Care. 2008; 4: 234-254.Google Scholar