Rheumatoid Arthritis Versus Osteoarthritis in Patients Receiving Revision Total Knee Arthroplasty in the United States: Increased Perioperative Risks? A National Database-Based Propensity Score–Matching Study

AbstractAs the use of disease modifying antirheumatic drugs have increased, it remains unclear whether or not this has affected the rates of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients. Therefore, the purpose of this study was to evaluate the annual trends of RA patients who underwent TKA. Specifically, we evaluated: (1) the annual trends of TKAs due to RA in the United States population; and (2) the annual trends in the proportion of TKAs due to RA in the United States. The Nationwide Inpatient Sample was used to identify all patients who underwent TKA between 2002 and 2013 (n = 6,492,873). Then, we identified TKA patients who had a diagnosis of RA, defined by the International Classification of Diseases, Ninth Revision (ICD-9) code 714.0. The incidence of TKAs with a diagnosis of RA in the United States was calculated using the U.S. population as the denominator. Regression models were used to analyze the annual trends of RA in patients who underwent TKA. A total of 209,332 RA patients were identified who underwent TKA. The annual prevalence of RA in patients who underwent TKA slightly increased, from 33.2 per 1,000 TKAs in 2002 to 35 per 1,000 TKAs in 2013 (R 2 = 0.254, p = 0.095). The annual number of TKAs with a diagnosis of RA increased by 93.1% from 11,618 to 22,430. After normalizing for the U.S. population, the incidence of TKAs with RA increased from 5.4 to 9.2 TKAs per 1 million U.S. adults (incidence rate ratio [IRR] = 1.05; 95% confidence interval [CI], 1.05–1.05; p < 0.001). In 2002, 11,618 (3.31%) TKAs, and in 2013, 22,430 (3.50%) TKAs were due to RA. The prevalence of RA in those who underwent TKA remained the same from 2002 to 2013 (coefficient = 0.02; 95% CI, –0.01 to 0.05; p = 0.095). The results of this study demonstrated that the rates of TKA performed in RA patients have remained relatively stable. Furthermore, there may have been a decline in the rate of RA patients undergoing TKA, due to an increase in the U.S. population by approximately 28.8 million during the study period.

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Migration Patterns for Revision Total Knee Arthroplasty in the United States as Reported in the American Joint Replacement Registry

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.06.005 ◽

2021 ◽

Author(s):

Kevin Lawson ◽

Antonia F. Chen ◽

Bryan Springer ◽

Richard Illgen ◽

David G. Lewallen ◽

...

Keyword(s):

United States ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Joint Replacement ◽

The United States ◽

Revision Total Knee Arthroplasty ◽

Migration Patterns ◽

Joint Replacement Registry ◽

Total Knee

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Current Epidemiology of Revision Total Knee Arthroplasty in the United States

The Journal of Arthroplasty ◽

10.1016/j.arth.2017.03.066 ◽

2017 ◽

Vol 32 (9) ◽

pp. 2663-2668 ◽

Cited By ~ 118

Author(s):

Ronald E. Delanois ◽

Jaydev B. Mistry ◽

Chukwuweike U. Gwam ◽

Nequesha S. Mohamed ◽

Ujval S. Choksi ◽

...

Keyword(s):

United States ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

The United States ◽

Revision Total Knee Arthroplasty ◽

Total Knee

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Use of Cementless Metaphyseal Fixation in Revision Total Knee Arthroplasty in the United States

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.11.027 ◽

2021 ◽

Author(s):

Christopher N. Carender ◽

Qiang An ◽

Matthew W. Tetreault ◽

Ayushmita De ◽

Timothy S. Brown ◽

...

Keyword(s):

United States ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

The United States ◽

Revision Total Knee Arthroplasty ◽

Metaphyseal Fixation ◽

Total Knee

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PMD12 GENDER DIFFERENCES IN TOTAL KNEE ARTHROPLASTY (TKA) POSTOPERATIVE PAIN MANAGEMENT IN THE UNITED STATES

Value in Health ◽

10.1016/j.jval.2011.02.452 ◽

2011 ◽

Vol 14 (3) ◽

pp. A81

Author(s):

R.M. Graver ◽

M. Domyahn ◽

C.E. Read ◽

A.M. Menzie ◽

S.R. Feinglass

Keyword(s):

United States ◽

Gender Differences ◽

Total Knee Arthroplasty ◽

Pain Management ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Postoperative Pain Management ◽

The United States ◽

Total Knee

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The Rise of Obesity among Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1710566 ◽

2020 ◽

Author(s):

Nequesha S. Mohamed ◽

Wayne A. Wilkie ◽

Ethan A. Remily ◽

Iciar M. Dávila Castrodad ◽

Mirlande Jean-Pierre ◽

...

Keyword(s):

Morbid Obesity ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

The United States ◽

National Database ◽

Categorical Variables ◽

Morbidly Obese ◽

Obese Patients ◽

Total Knee ◽

Nonobese Patients

AbstractIn the United States, one-third of adults are considered obese, and demand for total knee arthroplasty (TKA) is expected to rise in these patients. Surgeons are reluctant to operate on obese patients, but it is important to understand how obesity has affected TKA utilization. This study utilizes a national database to evaluate incidence, demographics, outcomes, charges, and cost in nonobese, overweight, nonmorbidly obese, and morbidly obese TKA patients. We queried the National Inpatient Sample from 2009 to 2016 for primary TKA patients identifying 4,053,037 nonobese patients, 40,077 overweight patients, 809,649 nonmorbidly obese patients, and 428,647 morbidly obese patients. Chi-square was used to analyze categorical variables, and one-way analysis of variance was used to analyze continuous variables. Nonmorbidly obese and morbidly obese patients represented 23.2% of all TKAs. TKA utilization increased 4.1% for nonobese patients, 121.6% for overweight patients, 73.6% for nonmorbidly obese patients, and 83.9% for morbidly obese patients. Morbidly obese patients were younger (p < 0.001), female (p < 0.001), Black (p < 0.001), poor (p < 0.001), and utilized private insurance (p < 0.001). They also had the longest length of stay (p < 0.001) and the highest mortality rate (p < 0.001). More morbidly obese patients were discharged to other facilities (p < 0.001), and they had the highest rate of complications (p < 0.001). Patients with morbid obesity had the highest charges (p < 0.001), but overweight patients had the highest costs (p < 0.001). The results of this study demonstrate the rise in obese and morbidly obese patients seeking TKAs, which may be reflection of the obesity epidemic in America. Although TKA utilization has increased for morbidly obese patients, this body mass index (BMI) category also has the highest rates of charges and complications, suggesting morbid obesity to be a modifiable risk factor leading to worse surgical and economic outcomes. Obese patients undergoing TKA may benefit from preoperative optimization of their weight, in an effort to reduce the risk of adverse outcomes.

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