Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Do Rheumatoid Arthritis Patients Expect Less From Total Knee Arthroplasty?

Ghomrawi1,  Hassan, Mandl2,  Lisa A., Johnson2,  Beverly, Alexiades2,  Michael, Goodman2,  Susan M.

Weil-Cornell Medical College, NYC, NY
Hospital for Special Surgery, New York, NY

Background/Purpose:

RA patients undergoing TKA often do not achieve the same functional results as osteoarthritis (OA) patients, yet are surprisingly satisfied. Satisfaction is determined not just by absolute improvements in pain and function, but also by fulfillment of pre-operative expectations. It is unknown if RA patients have different expectations compared to similar OA patients.

Methods:

RA patients undergoing TKA were compared to OA patients matched for age, gender, and lower extremity activity (LEAS) score. All were drawn from a prospective institutional registry, patients with previous arthroplasties were excluded. Expectations were assessed using the validated Hospital for Special Surgery Expectations Survey (see Table 1). A composite score is calculated; range: 0–100; 100=highest expectations. Preoperative data collection also included level of education, living situation, WOMAC, VAS for pain, ED-5Q, SF-36. Wilcoxon Signed Ranks test with Bonferroni correction was used to compare individual expectation items and T-test for mean expectations score.

Table 1. Comparisons of Pre-operative Expectations in OA vs. RA

 OA ControlsWilcoxon Signed Ranks Test
Knee Expectations Items P-value
Relief of painHigher0.127
Improve ability to walk short distance (indoors, 1 block)Higher0.036
Improve ability to walk medium distance (take a walk, < 1 mile)Higher0.097
Improve ability to walk long distance (> 1 mile)Higher0.254
Remove the need for a cane, crutch or walkerHigher0.012
Make knee or leg straightHigher0.015
Improve ability to go up stairsHigher0.007
Improve ability to go down stairsHigher0.012
Improve ability to kneelHigher0.503
Improve ability to squatHigher0.083
Improve ability to use public transportation, driveHigher0.006
Be employed for monetary reimbursementHigher0.489
Improve ability to participate in recreation (e.g. dancing, pleasure travel)Higher0.071
Improve ability to perform daily activities (e.g., household chores, daily routine)Higher<0.0026
Improve ability to exercise or participate in sportsHigher0.015
Improve ability to change position (e.g. go from sitting to standing or from standing to sitting)Higher0.003
Improve ability to interact with others (for example, take care of someone, play with children)Higher<0.0026
Improve sexual activityHigher0.036
Improve psychological well-beingHigher0.003
Bonferroni corrected significant P-value <0.0026

Results:

62 RA patients were identified and matched to 124 OA controls. 87.1% were women, average age was 64.7±9.7 years, and average LEAS was 8.7±3.1 (range 2–17), which corresponds to being able to walk around the house and for several blocks without assistance. Other differences were statistically but unlikely clinically significant (see Table 2). There was no difference in living status or education. RA patients had a significantly lower expectations score than OA patients (mean 73.7 vs. 79.8 (p-value=0.03); a difference >6 is clinically meaningful. Scores on multiple individual expectations items were also lower for RA patients, but with a Bonferroni correction only statistically significant for two (see Table 2). In addition, RA patients had lower ED-5Q scale scores suggesting RA patients place a lower value on their current health state.

Table 2. Pre-Operative Data

VariableRA Cases N=62OA Controls N=124P-value
Expectations score73.7 ± 18.579.8 ± 17.10.030
WOMAC Pain10.8 ± 2.89.8 ± 3.30.040
WOMAC Stiffness5.1 ± 1.54.7 ± 1.60.188
WOMAC Function38.6 ± 11.234.7 ± 11.90.048
SF-36 PCS29.3 ± 7.732.5 ± 7.80.009
SF-36 MCS45.4 ± 13.148.2 ± 13.10.190
EQ5D scale62.9 ± 21.671.1 ± 20.40.017
EQ5D score0.6 ± 0.20.6 ± 0.20.279

Conclusion:

Compared to matched OA patients, RA patients had clinically meaningful differences in overall expectations prior to TKA. They also had lower expectations for multiple individual items, and also placed lower value on their pre-operative heath state. This may explain the discrepancy between higher satisfaction and lower functional outcomes in RA patients. In the anti-TNF era, RA patients may be inappropriately accepting poorer outcomes. This raises the possibility they may not be optimizing their post-surgical outcomes.

To cite this abstract, please use the following information:
Ghomrawi, Hassan, Mandl, Lisa A., Johnson, Beverly, Alexiades, Michael, Goodman, Susan M.; Do Rheumatoid Arthritis Patients Expect Less From Total Knee Arthroplasty? [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1694
DOI:

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