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Same-Day Double Knee Replacements Safe for Some With RA

Same-day bilateral knee replacement surgery is safe for select patients with rheumatoid arthritis, according to researchers at Hospital for Special Surgery in New York City.

A release from the hospital notes that senior study author Mark Figgie, M.D. explains that in general, patients with an inflammatory systemic disease such as rheumatoid arthritis (RA) are sicker than patients with the degenerative condition osteoarthritis (OA).  Because RA patients are more likely to have conditions such as vasculitis or heart disease, and may be on medications that suppress the immune system that could make surgery more complicated, many RA patients who need both knees replaced have separate surgeries on different days.

However Dr. Figgie and colleagues found that select patients with RA do just as well with same-day bilateral knee replacement as OA patients, and with no higher complication rate. The study, "Rheumatoid Arthritis Does Not Increase Perioperative Complications Following Same-day Bilateral TKA," was presented at the annual meeting of the American Academy of Orthopaedic Surgeons in New Orleans on March 13th, 2014.

Dr. Figgie and colleagues analyzed hospital data from 240 RA patients and 3,680 OA patients who had bilateral knee replacement surgeries between 1998 and 2011. On average, the RA patients were about five years younger but were more likely to be obese or have significant heart disease. More than 80 percent of the RA patients were women.

The average hospital stay was slightly higher for RA patients, a difference of 5.8 days versus 5.4 days for the OA patients. The RA group was more likely to have acute postoperative anemia (17% versus 8% for OA patients) and blood transfusions (84% versus 77% for OA patients), but had similar rates of transfer to either the ICU or a rehabilitation facility. Researchers found no differences in the overall rates of procedure-related, minor and major complications between the two groups.

Rheumatoid arthritis patients should be carefully screened for surgery with stress tests, Dr. Figgie says. Although the bilateral procedure appears safe in RA patients without significant heart disease, he says, "These are typically more challenging cases, and surgeons will want to coordinate patient care with rheumatologists to avoid flares during the postoperative period." 

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