Susan M Goodman1, Danielle N Ramsden-Stein2, Wei-Ti Huang2, Rebecca Zhu2, Mark P Figgie2, Michael M Alexiades2, Lisa A Mandl2. 1. From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery. GoodmanS@HSS.edu. 2. From the Division of Rheumatology, and the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.S.M. Goodman, MD, Associate Professor of Clinical Medicine, Associate Attending Physician, Rheumatology; M.P. Figgie, MD, Professor of Orthopedic Surgery, Attending Orthopedic Surgeon, Chief of Surgical Arthritis Service; M.M. Alexiades, MD, Associate Professor of Orthopedic Surgery, Associate Attending; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Assistant Attending Physician, Rheumatology, Weill Cornell Medicine College, Hospital for Special Surgery; D.N. Ramsden-Stein, MD, Fellow, Rheumatology; W-T. Huang, MS, Biostatistician; R. Zhu, BA, Research Assistant, Research and Rheumatology, Hospital for Special Surgery.
Abstract
OBJECTIVE: Total hip replacement (THR) outcomes have been worse for patients with rheumatoid arthritis (RA) compared with those who have osteoarthritis (OA). Whether this remains true in contemporary patients with RA with a high use of disease-modifying and biologic therapy is unknown. The purpose of our study is to assess pain, function, and quality of life 2 years after primary THR, comparing patients with RA and patients with OA. METHODS: Baseline and 2-year data were compared between validated patients with RA and patients with OA who were enrolled in a single-center THR registry between May 1, 2007, and February 25, 2011. RESULTS: There were 5666 eligible primary THR identified, of which 193 were for RA. RA THR had worse baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain (44.8 vs 53.2, p < 0.001) and function (38.7 vs 49.9, p < 0.001) compared with OA. These differences remained after surgery: pain (88.4 vs 94.0, p < 0.001) and function (82.9 vs 91.8, p < 0.001). Patients with RA were as likely to have a significant improvement as patients with OA (Δ WOMAC > 10) in pain (94% vs 96%, p = 0.35) and function (95% vs 94%, p = 0.69), but were 4 times as likely to have worse function (WOMAC ≤ 60; 19% vs 4%, p < 0.001) and pain (12% vs 3%, p < 0.001). In multivariate logistic regression controlling for multiple potential confounders, RA increased the odds of poor postoperative function (OR 4.32, 95% CI 1.57-11.9), and in patients without a previous primary THR, worse postoperative pain (OR 3.17, 95% CI 1.06-9.53). CONCLUSION: Contemporary patients with RA have significant improvements in pain and function after THR, but higher proportions have worse 2-year pain and function. In addition, RA is an independent predictor of 2-year pain and poor function after THR, despite high use of disease-modifying therapy.
OBJECTIVE: Total hip replacement (THR) outcomes have been worse for patients with rheumatoid arthritis (RA) compared with those who have osteoarthritis (OA). Whether this remains true in contemporary patients with RA with a high use of disease-modifying and biologic therapy is unknown. The purpose of our study is to assess pain, function, and quality of life 2 years after primary THR, comparing patients with RA and patients with OA. METHODS: Baseline and 2-year data were compared between validated patients with RA and patients with OA who were enrolled in a single-center THR registry between May 1, 2007, and February 25, 2011. RESULTS: There were 5666 eligible primary THR identified, of which 193 were for RA. RA THR had worse baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain (44.8 vs 53.2, p < 0.001) and function (38.7 vs 49.9, p < 0.001) compared with OA. These differences remained after surgery: pain (88.4 vs 94.0, p < 0.001) and function (82.9 vs 91.8, p < 0.001). Patients with RA were as likely to have a significant improvement as patients with OA (Δ WOMAC > 10) in pain (94% vs 96%, p = 0.35) and function (95% vs 94%, p = 0.69), but were 4 times as likely to have worse function (WOMAC ≤ 60; 19% vs 4%, p < 0.001) and pain (12% vs 3%, p < 0.001). In multivariate logistic regression controlling for multiple potential confounders, RA increased the odds of poor postoperative function (OR 4.32, 95% CI 1.57-11.9), and in patients without a previous primary THR, worse postoperative pain (OR 3.17, 95% CI 1.06-9.53). CONCLUSION: Contemporary patients with RA have significant improvements in pain and function after THR, but higher proportions have worse 2-year pain and function. In addition, RA is an independent predictor of 2-year pain and poor function after THR, despite high use of disease-modifying therapy.
Authors: Susan M Goodman; Serene Z Mirza; Edward F DiCarlo; Diyu Pearce-Fisher; Meng Zhang; Bella Mehta; Laura T Donlin; Vivian P Bykerk; Mark P Figgie; Dana E Orange Journal: Arthritis Care Res (Hoboken) Date: 2020-05-14 Impact factor: 4.794
Authors: Susan M Goodman; Beverly Johnson; Meng Zhang; Wei-Ti Huang; Rebecca Zhu; Mark Figgie; Michael Alexiades; Lisa A Mandl Journal: J Rheumatol Date: 2015-12-01 Impact factor: 4.666
Authors: Michael D Richter; Cynthia S Crowson; Eric L Matteson; Ashima Makol Journal: Arthritis Care Res (Hoboken) Date: 2018-09-07 Impact factor: 4.794