Complications challenge rheumatoid arthritis patients after joint replacement surgery

November 28, 2012

In the first systemic review of evidence assessing complications following total joint arthroplasty, patients with rheumatoid arthritis (RA) were found to have an increased risk for hip dislocation after hip replacement surgery compared to those with osteoarthritis (OA). Study findings published online in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR), also indicate that RA patients have a higher infection risk following total knee replacement than patients with OA.

The ACR reports that OA—the most common form of —affects 27 million Americans 25 years of age and older, and another 1.3 million adults are living with RA. Previous studies show that one of the most effective treatment options for end-stage arthritis of the hip or knee is total joint replacement. Experts suggest that success with this intervention is evident given the increasing rates of joint replacements. According to the Centers for Disease Control and Prevention (CDC) 676,000 total knee replacements and 327,000 total hip replacements were performed in the U.S. in 2009.

"Joint arthroplasty is successful in relieving the pain and disability caused by hip or knee arthritis," said lead author Dr. Bheeshma Ravi from the University of Toronto and Women's College Research Institute (WCRI) in Canada. "While complication rates are low there are some cases with serious consequences that include infection, joint dislocation, blood clots and even death."

To explore this important issue, Dr. Ravi and colleagues conducted a systemic review of the literature to assess complication risk in OA and RA patients following joint replacement surgery. Evidence from January 1990 to December 2011 was evaluated and 40 studies were included in the analysis. The study population included patients aged 18 years or older who had hip or knee replacements and excluded patients who had replacement surgery due to a fracture or cancer. Studies that involved 200 joints or more were incorporated in the current analysis.

Analysis shows RA patients had a higher risk of dislocation following than patients with OA. RA patients who had total knee replacements were also at higher risk of infection compared to those with OA. The team found no difference in revision rate, 90-day mortality or blood clot risk between the two patient groups. Dr. Ravi concludes, "Additional studies to confirm our findings are necessary and further investigation of possible reasons for differences in joint replacement complication rates between RA and OA is needed."

Explore further: Joint replacement surgery riskier at hospitals with low surgical volume

More information: "A Systematic Review and Meta-analysis Comparing Complications following Total Joint Arthroplasty for Rheumatoid Arthritis versus Osteoarthritis." Bheeshma Ravi, Benjamin Escott, Prakesh S Shah, Richard Jenkinson, Jas Chahal, Earl Bogoch, Hans Kreder, Gillian Hawker. Arthritis & Rheumatism; Published Online: November 28, 2012 (DOI: 10.1002/art.37690).

Related Stories

UK says metal hip replacements more troublesome

September 16, 2011

(AP) -- People who get metal hip replacements are more likely to need a replacement compared to those who get a traditional plastic one, according to a new report from a large British registry.

Knee replacement surgery incidence soars in those over age 50

January 17, 2012

Researchers in Finland found that annual cumulative incidences of partial and total knee arthroplasty, commonly known as knee replacement surgery, rose rapidly over a 27-year period among 30 to 59 year-olds in that country, ...

Knee replacement not an 'easy solution' for obese patients

October 24, 2012

Obese patients have a greater risk of complications following total knee replacement surgery, including post-surgical infections, according to a new literature review recently published in the Journal of Bone and Joint Surgery ...

Recommended for you

Team finds gene that confirms existence of psoriatic arthritis

February 5, 2015

PsA is a common form of inflammatory form of arthritis causing pain and stiffness in joints and tendons that can lead to joint damage. Nearly all patients with PsA also have skin psoriasis and, in many cases, the skin disease ...

Blocking one receptor could halt rheumatoid arthritis

September 10, 2014

Researchers at the University of Illinois at Chicago College of Medicine have shown for the first time how the activation of a receptor provokes the inflammation and bone degradation of rheumatoid arthritis—and that activation ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.