Outcomes in patients with rheumatoid versus osteoarthritis for total hip arthroplasty: A meta-analysis and systematic review

Dislocation incidence and risk factors following direct anterior primary total hip arthroplasty: a consecutive, single-surgeon cohort

BACKGROUNDS

Dislocation is one of the debilitating complications of total hip arthroplasty. It is a common reason for revision surgery after THA, along with other complications such as infection and instability. This study determined the incidence and risk factors of dislocation after primary total hip arthroplasty using the direct anterior approach.

METHODS

Retrospective Data from patients who underwent primary THA from 2013 to 2020 was analyzed. Anteversion and inclination angles were extracted from their imaging studies, and demographic data were also recorded from their medical records. Data were analyzed using SPSS version 26.

RESULTS

One thousand two hundred four cases of THA were reviewed in our study. 31 (2.57%) dislocations happened after a minimum follow-up of five years. Our study showed that DDH diagnosis as the underlying condition, using Wagner Cone and Wagner SL stem, cup size smaller than 52, head size smaller than 34, anteversion and inclination angle outside the Lewinnek safe zone can be risk factors for dislocation. Primary OA and Fitmore stem acted as protective factors for dislocation.

CONCLUSION

In the DA approach, the underlying disease, properties of the prosthesis used such as cup and head size, stem type, and anteversion and inclination angles can be the potential risk factors for dislocation.

LEVEL OF EVIDENCE

III.

Global research trends and hotspots in rheumatoid arthritis joint replacement:Bibliometric analysis and visualization study

Objective

This study aims to analyze and visualize global research trends and hotspots in rheumatoid arthritis joint replacement over the past two decades using CiteSpace and VOSviewer software.The findings from this bibliometric analysis will inform and guide future research directions in this field.

Methods

We searched for relevant literature on rheumatoid arthritis joint replacement from January 2005 to August 2024 in the Web of Science database.Using CiteSpace, VOSviewer,and Bibliometrix software,we analysed keywords, authors,institutions, countries,and journals,and constructed a network cooperation map.

Results

A total of 2888 articles written by 11,723 authors from 70 countries and 3194 institutions were analysed and published in 530 journals.The United States, with 855 publications accounting for 29.61%of the world's total,and the United Kingdom, with 332 publications representing 11.50 %,made the greatest contributions.Additionally,the United States maintains strong collaborative relationships with many countries. According to the analysis of the outbreak keyword map, the joint replacement of rheumatoid arthritis has become mature, and the complications, prognosis and functional rehabilitation of joint replacement are the main focus of research in this field.

Conclusion

we conducted a comprehensive summary of the literature on rheumatoid arthritis joint replacement published between 2005 and 2024 using bibliometrics and visual analysis.This enabled us to identify the development trends and research hotspots in this field over the past two decades, offering valuable insights for researchers planning future studies in this area.

Synovial macrophage diversity and activation of M-CSF signaling in post-traumatic osteoarthritis

Synovium is home to immune and stromal cell types that orchestrate inflammation following a joint injury; in particular, macrophages are central protagonists in this process. We sought to define the cellular and temporal dynamics of the synovial immune niche in a mouse model of post-traumatic osteoarthritis (PTOA), and to identify stromal-immune crosstalk mechanisms that coordinate macrophage function and phenotype. We induced PTOA in mice using a non-invasive tibial compression model of anterior cruciate ligament rupture (ACLR). Single-cell RNA-sequencing and flow cytometry were used to assess immune cell populations in healthy (Sham) and injured (7 and 28 days post-ACLR) synovium. Characterization of synovial macrophage polarization states was performed, alongside computational modeling of macrophage differentiation, as well as implicated transcriptional regulators and stromal-immune communication axes. Immune cell types are broadly represented in healthy synovium, but experience drastic expansion and speciation in PTOA, most notably in the macrophage portion. We identified several polarization states of macrophages in synovium following joint injury, underpinned by distinct transcriptomic signatures, and regulated in part by stromal-derived macrophage colony-stimulating factor signaling. The transcription factors Pu.1, Cebpα, Cebpβ, and Jun were predicted to control differentiation of systemically derived monocytes into pro-inflammatory synovial macrophages. In summary, we defined different synovial macrophage subpopulations present in healthy and injured mouse synovium. Nuanced characterization of the distinct functions, origins, and disease kinetics of macrophage subtypes in PTOA will be critical for targeting these highly versatile cells for therapeutic purposes.

Perioperative Considerations for Hip Arthroplasty in Patients with Rheumatoid Arthritis

Due to its distinct features, rheumatoid arthritis (RA), an inflammatory autoimmune disorder, poses challenges in planning for surgical interventions. This review includes available evidence regarding perioperative considerations in management of RA patients, with a focus on hip surgery. RA can affect multiple joints, with development of extra-articular manifestations; therefore, preoperatively, comprehensive medical assessments, including cardiovascular or pulmonary evaluation must be considered in addition to surgical considerations. Modification of medications capable of controlling RA-related disease activity is critical, and requires collaboration with rheumatologists. Surgical considerations include the choice of surgical approach, implant selection, and problems related to weakened soft tissues, fragile bone density, and bony deformity such as protrusio acetabuli. Careful monitoring and more active rehabilitation are recommended for RA patients due to higher risk of postoperative complications. For achievement of optimal outcomes, use of a multidisciplinary perioperative approach is required for patients with RA.

Patient-Reported Outcome Measures After Direct Anterior Total Hip Arthroplasty Are Comparable Between Patients With Rheumatoid Arthritis and Osteoarthritis: A Propensity-Matched Analysis

INTRODUCTION

It is currently unclear whether patients with rheumatoid arthritis have similar functional outcomes after total hip arthroplasty (THA) as those with osteoarthritis, particularly given that rheumatoid arthritis may have systemic manifestations in terms of pain and function. The purpose of this study was to compare patient-reported outcome measures between patients with rheumatoid arthritis and matched control patients with osteoarthritis who underwent direct anterior THA.

METHODS

All patients who underwent direct anterior THA from 2010 to 2022 at a single academic institution were retrospectively reviewed. Hips with rheumatoid arthritis were propensity matched to hips with osteoarthritis on a 1:4 basis. Patient-reported outcome measures, including visual analog scale (VAS) pain at rest and with use, Hip Disability and Osteoarthritis Outcome Score Pain, and Forgotten Joint Score-12, were obtained at follow-up. In addition, modified Harris Hip Scores (mHHS) were obtained both preoperatively and at the final follow-up.

RESULTS

Forty-six hips with rheumatoid arthritis and 184 hips with osteoarthritis were followed for a mean of 6.3 ± 3.6 years. Both cohorts demonstrated notable preoperative to postoperative improvements in mHHS (P < 0.001). No differences were observed at the final follow-up between cohorts for VAS at rest (0.8 vs. 0.5, P = 0.333), VAS with use (1.3 vs. 0.9, P = 0.234), Hip Disability and Osteoarthritis Outcome Score Pain (90.4 vs. 93.6, P = 0.113), Forgotten Joint Score-12 (80.3 vs. 82.8, P = 0.529), and mHHS (86.9 vs. 89.0, P = 0.335). One patient with rheumatoid arthritis had an intraoperative periprosthetic calcar fracture, whereas none underwent subsequent revision THA.

CONCLUSION

Patients with rheumatoid arthritis and osteoarthritis who underwent direct anterior THA achieved comparable outcomes in this propensity-matched analysis. Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA.

Is Total Joint Arthroplasty an Effective and Safe Option for Psoriatic Arthritis Patients? A Scoping Review

Recent advancements in the treatment of psoriatic arthritis (PsA) have improved patient outcomes, but many still experience disease progression, potentially leading to joint replacement surgery. In this scoping review, we examine the relationship between PsA and orthopedic surgery, focusing on the risks and temporal trends of total hip arthroplasty (THA) and total knee arthroplasty (TKA), the prevalence of postoperative complications, and the effectiveness of these procedures in PsA. The included studies suggest that PsA patients have an overall higher risk of undergoing THA and TKA compared to the general population, but with temporal trends showing a decreased risk for patients diagnosed in recent years. Acute complications, such as renal failure, stroke, and postoperative infections, may be more common in PsA patients than in those with osteoarthritis after THA and TKA. No significant differences were found in pain, function, or satisfaction between PsA, skin psoriasis, and osteoarthritis patients after THA. A key conclusion from our review is the need to strengthen the collaboration between rheumatologists and orthopedic surgeons, as interdisciplinary evaluation is crucial for improving the outcomes of PsA patients undergoing orthopedic surgery.

Rheumatoid arthritis is associated with higher 90-day systemic complications compared to osteoarthritis after total shoulder arthroplasty: a cohort study

BACKGROUND

Total shoulder arthroplasty (TSA) in patients with rheumatoid arthritis (RA) can present unique challenges. The aim of this study was to compare both systemic and joint-related postoperative complications in patients undergoing primary TSA with RA versus those with primary osteoarthritis (OA).

METHODS

Using the TriNetX database, Current Procedural Terminology and International Classification of Diseases, 10th edition codes were used to identify patients who underwent primary TSA. Patients were categorized into two cohorts: RA and OA. After 1:1 propensity score matching, postoperative systemic complications within 90 days following primary TSA and joint-related complications within 5 years following anatomic TSA (aTSA) and reverse shoulder arthroplasty (RSA) were compared.

RESULTS

After propensity score matching, the RA and OA cohorts each consisted of 8,523 patients. Within 90 days postoperation, RA patients had a significantly higher risk of total complications, deep surgical site infection, wound dehiscence, pneumonia, myocardial infarction, acute renal failure, urinary tract infection, mortality, and readmission compared to the OA cohort. RA patients had a significantly greater risk of periprosthetic joint infection and prosthetic dislocation within 5 years following aTSA and RSA, and a greater risk of scapular fractures following RSA. Among RA patients, RSA had a significantly higher risk of prosthetic dislocation, scapular fractures, and revision compared to aTSA.

CONCLUSIONS

Following TSA, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary OA. Knowledge of the risk profile of RA patients undergoing TSA is essential for appropriate patient counseling and education. Level of evidence: III.

Association between disease activity of rheumatoid arthritis and risk of complications following total hip arthroplasty: a retrospective cohort study

BACKGROUND

Identifying rheumatoid arthritis patients at higher risk of complications after total hip arthroplasty could make perioperative management more effective. Here we examined whether disease activity is associated with risk of such complications.

METHODS

We retrospectively analyzed data for 337 rheumatoid arthritis patients at our medical center who underwent primary total hip arthroplasty. Rheumatoid arthritis patients were categorized according to the simplified disease activity index (SDAI), the values of which at admission and follow-up were averaged together. Logistic regression was used to examine associations of mean SDAI with rates of dislocation, infection, periprosthetic fracture and aseptic loosening. As controls, 337 osteoarthritis patients who did not have systemic inflammation and who underwent the same procedure were matched across numerous clinicodemographic variables.

RESULTS

Among the 337 rheumatoid arthritis patients, 38 (11.3%) had postoperative complications, the rates of which varied significantly from 0 to 17.5% (p = 0.003) among the four subgroups whose disease activity based on mean SDAI was categorized as high, moderate, low or in remission. Each 1-unit increase in mean SDAI was associated with a significant increase in risk of postoperative complications (OR 1.015, 95% CI 1.001-1.029, p = 0.035). Across all rheumatoid arthritis patients, rate of complications did not differ significantly between patients who received disease-modifying anti-rheumatic drugs or other treatments. Rates of dislocation, of infection or of all postoperative complications combined were significantly lower among osteoarthritis controls than among rheumatoid arthritis patients.

CONCLUSION

Greater mean SDAI is associated with higher risk of dislocation, infection and composite postoperative complications after total hip arthroplasty in rheumatoid arthritis patients. These patients show a significantly higher rate of postoperative complications than osteoarthritis patients, likely reflecting the influence of systemic inflammation. Disease activity should be reduced as much as possible in rheumatoid arthritis patients before they undergo total hip arthroplasty.

[Outcome of joint replacement in patients with underlying rheumatoid disease]

BACKGROUND

Artificial joint replacement is a meaningful treatment option for patients with advanced rheumatic degenerative joint diseases. The aim of this study was to investigate the influence of the underlying rheumatic diseases on postoperative complications and patient-reported outcome (PRO) after elective total joint replacement (TJR).

MATERIAL AND METHODS

In a retrospective analysis of 9149 patients with elective total knee or total hip arthroplasty (TKR and THR), complication rates and PRO of patients with and without rheumatic diseases (RD) were compared. Multivariate logistic regression models were used to determine whether the underlying rheumatic disease was an independent risk factor for various complications.

RESULTS

In the univariate analyses the RD patients had an increased risk of medical complications (7.1% vs. 5.2%; p = 0.028) and Clavien-Dindo grade IV complications (2.8% vs. 1.8%; p = 0.048) after TJR. This was confirmed in multivariate statistical analyses (p < 0.034). The rates for operative revisions and surgical complications were comparable (2.5% vs. 2.4%; p = 0.485). Analysis of the PRO showed a higher responder rate in patients with RD after TKR (91.9% vs. 84.5%, p = 0.039). In contrast, the responder rate in patients with RD after THR was comparable (93.4% vs. 93.2%, p = 0.584).

CONCLUSION

Despite increased postoperative complication rates, patients with underlying rheumatic diseases showed a comparable outcome 1 year after TJR. After TKR the RD patients showed even higher responder rates. Although RD patients are a vulnerable patient group, they can still benefit from joint replacement.

Synovial macrophage diversity and activation of M-CSF signaling in post-traumatic osteoarthritis

Objective

Synovium is home to immune and stromal cell types that orchestrate inflammation following a joint injury; in particular, macrophages are central protagonists in this process. We sought to define the cellular and temporal dynamics of the synovial immune niche in a mouse model of post-traumatic osteoarthritis (PTOA), and to identify stromal-immune crosstalk mechanisms that coordinate macrophage function and phenotype.

Design

We induced PTOA in mice using a non-invasive tibial compression model of anterior cruciate ligament rupture (ACLR). Single cell RNA-seq and flow cytometry were used to assess immune cell populations in healthy (Sham) and injured (7d and 28d post-ACLR) synovium. Characterization of synovial macrophage polarization states was performed, alongside computational modeling of macrophage differentiation, as well as implicated transcriptional regulators and stromal-immune communication axes.

Results

Immune cell types are broadly represented in healthy synovium, but experience drastic expansion and speciation in PTOA, most notably in the macrophage portion. We identified several polarization states of macrophages in synovium following joint injury, underpinned by distinct transcriptomic signatures, and regulated in part by stromal-derived macrophage colony-stimulating factor signaling. The transcription factors Pu.1, Cebpα, Cebpβ, and Jun were predicted to control differentiation of systemically derived monocytes into pro-inflammatory synovial macrophages.

Conclusions

We defined different synovial macrophage subpopulations present in healthy and injured mouse synovium. Nuanced characterization of the distinct functions, origins, and disease kinetics of macrophage subtypes in PTOA will be critical for targeting these highly versatile cells for therapeutic purposes.

A systematic review and meta-analysis comparing outcomes following total knee arthroplasty for rheumatoid arthritis versus for osteoarthritis

PURPOSE

Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA.

METHODS

Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS).

RESULTS

Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24-2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37-3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61-0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78-0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60-2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54-0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01-0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47-1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79-2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87-1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56-5.48; P = 0.34) between the groups.

CONCLUSION

Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.

Sexual function and sexual activity in young total hip arthroplasty Chinese patients: A retrospective cohort study

Introduction

As an essential component of quality of life, there is limited evidence of sexual function (SF), especially for young patients, before and after total hip arthroplasty (THA). This study aims to enhance the understanding of SF status and assess patient perspectives before and after THA.

Methods

A total of 109 patients who received THA were enrolled into our retrospective cohort study. To assess the SF status before and after THA, patients were required to fill out a standardized SF questionnaire [female sexual function index (FSFI) or brief sexual function inventory (BSFI) for males] and a specifically designated questionnaire regarding perspectives toward sexual activity and attitudes to sexual-related information.

Results

Total average scores of both FSFI and BSFI were higher post-THA. For female patients, the FSFI scores were significantly higher in the domain of desire, orgasm, and satisfaction (p < 0.05). For male patients, the BSFI scores were also improved in the sex drive and satisfaction domain post-operation (p < 0.05). A large proportion of the patients (64.22%) reported difficulty in sexual activity preoperatively, primarily due to restricted motion (82.86%) and hip pain (74.29%). After a successful procedure, there was a reduction in difficulty in patients' sexual activity post-THA (39.45%), mainly attributed to less pain (72.09%) and greater mobility (79.07%). In addition, subgroup analysis results indicated that gender and severity of hip stiffness and pain were crucial factors that could affect the patient's SF status. Furthermore, the majority of patients reported that they desired information concerning sexual activity, but only 12.84% of patients were informed well. Patients' preferred channels to acquire sexual-related information was a booklet (65.59%, n = 61), followed by informing a surgeon and a nurse. The most concerning questions regarding the sexual activity of patients were the time to recovery (90.32%) and safe postures (76.34%).

Conclusion

The majority of men and women who underwent THA reported their SF status return to baseline or have improved, mainly attributable to less pain and greater mobility. Age and severity of hip pain/stiffness were the factors that could affect patients' SF status. Sexual education for young THA patients is needed due to the lack of related information during hospitalization.