Abstract
Over 25% of patients with rheumatoid arthritis (RA) are expected to undergo a joint
replacement during their lifetime. Current practice guidelines recommend withholding
biologic therapy 1 week prior to total hip arthroplasty, given its immunosuppressive
effects. Most patients are on a regimen including biologic and nonbiologic therapy;
however, the individual influences of these therapies are not well understood in the
setting of total knee arthroplasty (TKA). Therefore, we sought to compare biologic,
nonbiologic, and recipients of both types of therapy in patients with RA undergoing
TKA. We specifically assessed (1) medical complications at 90 days; (2) surgical complications
up to 1 year; and (3) independent risk factors for prosthetic joint infections (PJIs).
A retrospective review was conducted using a national, all-payer database for patients
undergoing primary TKA from January 2010 to April 2020 (n = 1.97 million). Patients diagnosed with RA were then separated into at least 1-year
users of biologic (n = 3,092), nonbiologic (28,299), or dual (n = 10,949) therapy. Bivariate analyses were utilized to assess for 90-day medical
and up to 1-year surgical outcomes. Additionally, multivariate regression models were
utilized to assess for independent risk factors.
The incidence and odds ratio for medical/surgical outcomes were equivocal among the
biologic, nonbiologic, and recipients receiving both types of therapy (p > 0.061). No differences were observed between the type of therapy as additional
risk factors for infection (p > 0.505). However, glucocorticoids at 90 days and alcohol abuse, diabetes mellitus,
obesity, as well as tobacco use were identified as additional risk factors for PJI(p < 0.036).
No appreciable differences in medical or surgical outcomes were associated with the
independent use of biologic, nonbiologic, or recipients of both types of therapy in
patients with RA. Additionally, alcohol abuse, diabetes mellitus, glucocorticoids,
obesity, and tobacco use conferred an increased risk of PJI. These results can serve
as an adjunct to current practice guidelines.
Keywords
DMARDs - TKA - biologics - nonbiologics
