Comparison of Expectations and Outcomes in Rheumatoid Arthritis Versus Osteoarthritis Patients Undergoing Total Knee Arthroplasty

Jason L. Blevins, Yu Fen Chiu, Leonard Lyman Stephen, Susan M. Goodman, Lisa A. Mandl, Peter K. Sculco, Mark P. Figgie, Alexander S. McLawhorn

Research output: Contribution to journalArticle

Abstract

Background: We hypothesized that patients undergoing primary total knee arthroplasty (TKA) for rheumatoid arthritis (RA) would have different preoperative expectations compared to osteoarthritis (OA) patients, and that postoperative satisfaction would correlate with specific postoperative pain and functional domains. Methods: This is a retrospective cohort study of RA patients matched based on age, gender, American Society of Anesthesiologists score, and Charlson Comorbidity Index score 1:2 with OA patients (76 RA, 152 OA) who underwent primary TKA. The Hospital for Special Surgery Knee Replacement Expectations Survey, Visual Analogue Scale for Pain (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and the Short Form-12 (SF-12) were compared at baseline and at 2 years postoperatively. Minimum clinically important differences (MCIDs) were calculated for KOOS and SF-12 subdomains. Results: Preoperatively, RA patients had lower expectations, worse VAS Pain, and worse KOOS Pain, Symptoms, and Activities of Daily Living (P <.05). However, at 2 years, RA patients had significantly larger improvements in VAS (P =.01) and these 3 KOOS subdomains (P <.05), achieving comparable absolute scores to OA patients. Overall, 86.1% of RA and 87.1% of OA patients were either somewhat or very satisfied with their TKA. Patient satisfaction correlated with VAS Pain and KOOS outcome scores in both groups. RA and OA patients had high rates of achieving MCID in SF-12 physical component scores and all 5 KOOS subdomains. A higher proportion of RA patients achieved MCID in KOOS Symptoms (98.4% vs 77.2%, P <.001). Conclusion: RA patients had lower baseline expectations compared to OA patients. However, RA patients had greater improvements in KOOS and SF-12 subdomains, and there was no difference in satisfaction compared to OA patients after TKA.

Original languageEnglish
Pages (from-to)1946-1952.e2
JournalJournal of Arthroplasty
Volume34
Issue number9
DOIs
Publication statusPublished - Sep 1 2019

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Knee Replacement Arthroplasties
Osteoarthritis
Rheumatoid Arthritis
Knee Injuries
Knee Osteoarthritis
Pain Measurement
Patient Satisfaction
Pain
Special Hospital
Activities of Daily Living
Postoperative Pain
Comorbidity
Knee

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

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Comparison of Expectations and Outcomes in Rheumatoid Arthritis Versus Osteoarthritis Patients Undergoing Total Knee Arthroplasty. / Blevins, Jason L.; Chiu, Yu Fen; Lyman Stephen, Leonard; Goodman, Susan M.; Mandl, Lisa A.; Sculco, Peter K.; Figgie, Mark P.; McLawhorn, Alexander S.

In: Journal of Arthroplasty, Vol. 34, No. 9, 01.09.2019, p. 1946-1952.e2.

Research output: Contribution to journalArticle

Blevins, Jason L. ; Chiu, Yu Fen ; Lyman Stephen, Leonard ; Goodman, Susan M. ; Mandl, Lisa A. ; Sculco, Peter K. ; Figgie, Mark P. ; McLawhorn, Alexander S. / Comparison of Expectations and Outcomes in Rheumatoid Arthritis Versus Osteoarthritis Patients Undergoing Total Knee Arthroplasty. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 9. pp. 1946-1952.e2.
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abstract = "Background: We hypothesized that patients undergoing primary total knee arthroplasty (TKA) for rheumatoid arthritis (RA) would have different preoperative expectations compared to osteoarthritis (OA) patients, and that postoperative satisfaction would correlate with specific postoperative pain and functional domains. Methods: This is a retrospective cohort study of RA patients matched based on age, gender, American Society of Anesthesiologists score, and Charlson Comorbidity Index score 1:2 with OA patients (76 RA, 152 OA) who underwent primary TKA. The Hospital for Special Surgery Knee Replacement Expectations Survey, Visual Analogue Scale for Pain (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and the Short Form-12 (SF-12) were compared at baseline and at 2 years postoperatively. Minimum clinically important differences (MCIDs) were calculated for KOOS and SF-12 subdomains. Results: Preoperatively, RA patients had lower expectations, worse VAS Pain, and worse KOOS Pain, Symptoms, and Activities of Daily Living (P <.05). However, at 2 years, RA patients had significantly larger improvements in VAS (P =.01) and these 3 KOOS subdomains (P <.05), achieving comparable absolute scores to OA patients. Overall, 86.1{\%} of RA and 87.1{\%} of OA patients were either somewhat or very satisfied with their TKA. Patient satisfaction correlated with VAS Pain and KOOS outcome scores in both groups. RA and OA patients had high rates of achieving MCID in SF-12 physical component scores and all 5 KOOS subdomains. A higher proportion of RA patients achieved MCID in KOOS Symptoms (98.4{\%} vs 77.2{\%}, P <.001). Conclusion: RA patients had lower baseline expectations compared to OA patients. However, RA patients had greater improvements in KOOS and SF-12 subdomains, and there was no difference in satisfaction compared to OA patients after TKA.",
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T1 - Comparison of Expectations and Outcomes in Rheumatoid Arthritis Versus Osteoarthritis Patients Undergoing Total Knee Arthroplasty

AU - Blevins, Jason L.

AU - Chiu, Yu Fen

AU - Lyman Stephen, Leonard

AU - Goodman, Susan M.

AU - Mandl, Lisa A.

AU - Sculco, Peter K.

AU - Figgie, Mark P.

AU - McLawhorn, Alexander S.

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AB - Background: We hypothesized that patients undergoing primary total knee arthroplasty (TKA) for rheumatoid arthritis (RA) would have different preoperative expectations compared to osteoarthritis (OA) patients, and that postoperative satisfaction would correlate with specific postoperative pain and functional domains. Methods: This is a retrospective cohort study of RA patients matched based on age, gender, American Society of Anesthesiologists score, and Charlson Comorbidity Index score 1:2 with OA patients (76 RA, 152 OA) who underwent primary TKA. The Hospital for Special Surgery Knee Replacement Expectations Survey, Visual Analogue Scale for Pain (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and the Short Form-12 (SF-12) were compared at baseline and at 2 years postoperatively. Minimum clinically important differences (MCIDs) were calculated for KOOS and SF-12 subdomains. Results: Preoperatively, RA patients had lower expectations, worse VAS Pain, and worse KOOS Pain, Symptoms, and Activities of Daily Living (P <.05). However, at 2 years, RA patients had significantly larger improvements in VAS (P =.01) and these 3 KOOS subdomains (P <.05), achieving comparable absolute scores to OA patients. Overall, 86.1% of RA and 87.1% of OA patients were either somewhat or very satisfied with their TKA. Patient satisfaction correlated with VAS Pain and KOOS outcome scores in both groups. RA and OA patients had high rates of achieving MCID in SF-12 physical component scores and all 5 KOOS subdomains. A higher proportion of RA patients achieved MCID in KOOS Symptoms (98.4% vs 77.2%, P <.001). Conclusion: RA patients had lower baseline expectations compared to OA patients. However, RA patients had greater improvements in KOOS and SF-12 subdomains, and there was no difference in satisfaction compared to OA patients after TKA.

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