Patient Satisfaction Following Total Knee Arthroplasty: Comparison of Short-Term Results in Rheumatoid Arthritis and Osteoarthritis

Document Type : RESEARCH PAPER

Authors

1 Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Due to the obvious differences in the natural course of rheumatoid arthritis (RA) and osteoarthritis (OA),
different functional outcomes might be expected after Total Knee Arthroplasty (TKA) in these distinct patients. Although
several studies have reported the objective outcome of TKA in RA and OA patients, few studies have compared postoperative
patient-satisfaction levels.
Methods: In this clinical cohort study 171 patients (RA: n=33, OA: n=138) who underwent TKA with posterior
stabilizing knee prosthesis were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford
Knee Score (OKS) were used to evaluate and compare patients’ satisfaction 6 and 12 months after TKA relative to
their preoperative state and to make an assessment between two groups.
Results: Both of patient-reported scoring systems showed a statistically significant improvement for OA and RA
patients at 6 and 12 months after surgery, relative to their preoperative scores. The results of the OKS and KOOS did
not show statistically significant improvement from 6 to 12 months n RA patients. Unlike RA group, OKS and KOOS
revealed further improvement between 6 and 12 months for the osteoarthritic patients.
Conclusion: OA patients had continuous improvement in their satisfaction in the first year after TKA with a gentle
upward curve. In contrast, in RA patients, recovery was faster and greater in the first six months after surgery and
slowed down in the second six months. Patient-reported outcome scores were not significantly different between two
groups at the end of the first year.
Level of evidence: II

Keywords

Main Subjects


1. Goodman SM, Johnson B, Zhang M, Huang WT,
Zhu R, Figgie M, et al. Patients with rheumatoid
arthritis have similar excellent outcomes after total
knee replacement compared with patients with
osteoarthritis. J Rheumatol. 2016; 43(1):46-53.
2. LoVerde ZJ, Mandl LA, Johnson BK, Figgie MP, Boettner
F, Lee YY, et al. Rheumatoid arthritis does not increase
risk of short-term adverse events after total knee
arthroplasty: a retrospective case-control study. J
Rheumatol. 2015; 42(7):1123-30.
3. Vigano R, Whiteside LA, Roy M. Clinical results of bone
ingrowth TKA in patients with rheumatoid arthritis.
Clin Orthop Relat Res. 2008; 466(12):3071-7.
4. Bade MJ, Stevens-Lapsley JE. Restoration of physical
function in patients following total knee arthroplasty:
an update on rehabilitation practices. Curr Opin
Rheumatol. 2012; 24(2):208-14.
5. Avramidis K, Karachalios T, Popotonasios K,
Sacorafas D, Papathanasiades AA, Malizos KN. Does
electric stimulation of the vastus medialis muscle
influence rehabilitation after total knee replacement?
Orthopedics. 2011; 34(3):175.
6. Cancienne JM, Werner BC, Browne JA. Complications
of primary total knee arthroplasty among patients
with rheumatoid arthritis, psoriatic arthritis,
ankylosing spondylitis, and osteoarthritis. J Am Acad
Orthop Surg. 2016; 24(8):567-74.
7. Singh JA, Inacio MC, Namba RS, Paxton EW. Rheumatoid
arthritis is associated with higher ninety-day hospital
readmission rates compared to osteoarthritis after
hip or knee arthroplasty: a cohort study. Arthritis
Care Res. 2015; 67(5):718-24.
8. Kiran A, Hunter DJ, Judge A, Field RE, Javaid MK,
Cooper C, et al. A novel methodological approach for
measuring symptomatic change following total joint
arthroplasty. J Arthroplasty. 2014; 29(11):2140-5.
9. Keurentjes JC, Van Tol FR, Fiocco M, So-Osman C,
Onstenk R, Koopman-Van Gemert AW, et al. Patient
acceptable symptom states after totalhip or knee
replacement at mid-term follow-up: Thresholds of
the Oxford hip and knee scores. Bone Joint Res. 2014;
3(1):7-13.
10. Kellgren JH, Lawrence JS. Radiological assessment
of rheumatoid arthritis. Ann Rheum Dis. 1957;
16(4):485-93.
11. Williams DP, Price AJ, Beard DJ, Hadfield SG, Arden NK,
Murray DW, et al. The effects of age on patient-reported
outcome measures in total knee replacements. Bone
Joint J. 2013; 95-B(1):38-44.
12. Johnston L, MacLennan G, McCormack K, Ramsay C,
Walker A. The Knee Arthroplasty Trial (KAT) design 
features, baseline characteristics, and two-year
functional outcomes after alternative approaches
to knee replacement. J Bone Joint Surg Am. 2009;
91(1):134-41.
13. Roos EM, Toksvig-Larsen S. Knee injury and
Osteoarthritis Outcome Score (KOOS) - validation and
comparison to the WOMAC in total knee replacement.
Health Qual Life Outcomes. 2003; 1:17.
14. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard
DJ, Carr AJ, et al. The use of the Oxford hip and knee
scores. J Bone Joint Surg Br. 2007; 89(8):1010-4.
15. Hamilton DF, Giesinger JM, Patton JT, MacDonald
DJ, Simpson AH, Howie CR, et al. Making the Oxford
Hip and Knee Scores meaningful at the patient level
through normative scoring and registry data. Bone
Joint Res. 2015; 4(8):137-44.
16. Sasaki E, Tsuda E, Yamamoto Y, Meada S, Otsuka H,
Ishibashi Y. Relationship between patient-based
outcome score and conventional objective outcome
scales in post-operative total knee arthroplasty
patients. Int Orthop. 2014; 38(2):373-8.
17. Cournapeau J, Klouche S, Bauer T, Hardy P. Survival
and functional results after a mean follow-up of 9
years with the Ceragyr® highly congruent mobilebearing
TKA. Orthop Traumatol Surg Res. 2015;
101(4):455-60.
18. Bistolfi A, Massazza G, Rosso F, Deledda D, Gaito V,
Lagalla F, et al. Cemented fixed-bearing PFC total knee
arthroplasty: survival and failure analysis at 12-17
years. J Orthop Traumatol. 2011; 12(3):131-6.
19. Ravi B, Escott B, Shah PS, Jenkinson R, Chahal J,
Bogoch E, et al. A systematic review and metaanalysis
comparing complications following
total joint arthroplasty for rheumatoid arthritis
versus for osteoarthritis. Arthritis Rheum. 2012;
64(12):3839-49.
20. Ravi B, Croxford R, Hollands S, Paterson JM, Bogoch
E, Kreder H, et al. Increased risk of complications
following total joint arthroplasty in patients with
rheumatoid arthritis. Arthritis Rheumatol. 2014;
66(2):254-63.
21. Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan
RF, Veth RP. Patient satisfaction after total knee
arthroplasty: a comparison between subjective and
objective outcome assessments. J Arthroplasty. 2001;
16(6):740-7.
22. Gill GS, Joshi AB. Long-term results of retention of the
posterior cruciate ligament in total knee replacement
in rheumatoid arthritis. J Bone Joint Surg Br. 2001;
83(4):510-2.