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The effect of rheumatoid arthritis on patient reported outcomes following knee and hip replacement: evidence from routinely collected data

The effect of rheumatoid arthritis on patient reported outcomes following knee and hip replacement: evidence from routinely collected data
The effect of rheumatoid arthritis on patient reported outcomes following knee and hip replacement: evidence from routinely collected data
Objectives
To compare outcomes of total knee replacement (TKR) and total hip replacement (THR) for individuals with RA and OA.

Methods
We performed a cohort study using routinely collected data. Oxford Knee Score, Oxford Hip Score, and EuroQol 5-dimension 3-level (EQ-5D-3L) questionnaires were collected before and 6 months after surgery. Multivariable regressions were used to estimate the association between diagnosis and post-operative scores after controlling for pre-operative scores and patient characteristics.

Results
Study cohorts included 2070 OA and 142 RA patients for TKR and 2030 OA and 98 RA patients for THR. Following TKR, the median Oxford Knee Score was 37 [interquartile range (IQR) 29–43] for OA and 36 (27–42) for RA while the median EQ-5D-3L was 0.76 (0.69–1.00) and 0.69 (0.52–0.85), respectively. After THR, the Oxford Hip Score was 42 (IQR 36–46) for OA and 39 (30–44) for RA while the EQ-5D-3L was 0.85 (0.69–1.00) and 0.69 (0.52–1.00), respectively. The estimated effect of RA, relative to OA, on post-operative scores was −0.05 (95% CI −1.57, 1.48) for the Oxford Knee Score, −0.09 (−0.13, −0.06) for the EQ-5D-3L following TKR, −1.35 (−2.93, −0.22) for the Oxford Hip Score, and −0.08 (−0.12, −0.03) for the EQ-5D-3L following THR.

Conclusion
TKR and THR led to substantial improvements in joint-specific scores and overall quality of life. While diagnosis had no clinically meaningful effect on joint-specific outcomes, improvements in general quality of life were somewhat less for those with RA, which is likely due to the systemic and multijoint nature of rheumatoid disease.
1462-0324
1016–1024
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Edwards, Christopher
dcb27fec-75ea-4575-a844-3588bcf14106
Murray, David W.
fa0e1764-e600-42bd-937d-6d7e5d623bbc
Silman, Alan J.
1ab1fc13-51f5-44c8-92f1-0bb32a5c5754
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Pinedo Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Edwards, Christopher
dcb27fec-75ea-4575-a844-3588bcf14106
Murray, David W.
fa0e1764-e600-42bd-937d-6d7e5d623bbc
Silman, Alan J.
1ab1fc13-51f5-44c8-92f1-0bb32a5c5754
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Pinedo Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9

Burn, Edward, Edwards, Christopher, Murray, David W., Silman, Alan J., Cooper, Cyrus, Arden, Nigel, Pinedo Villanueva, Rafael and Prieto-Alhambra, Daniel (2019) The effect of rheumatoid arthritis on patient reported outcomes following knee and hip replacement: evidence from routinely collected data. Rheumatology, 58 (6), 1016–1024. (doi:10.1093/rheumatology/key409).

Record type: Article

Abstract

Objectives
To compare outcomes of total knee replacement (TKR) and total hip replacement (THR) for individuals with RA and OA.

Methods
We performed a cohort study using routinely collected data. Oxford Knee Score, Oxford Hip Score, and EuroQol 5-dimension 3-level (EQ-5D-3L) questionnaires were collected before and 6 months after surgery. Multivariable regressions were used to estimate the association between diagnosis and post-operative scores after controlling for pre-operative scores and patient characteristics.

Results
Study cohorts included 2070 OA and 142 RA patients for TKR and 2030 OA and 98 RA patients for THR. Following TKR, the median Oxford Knee Score was 37 [interquartile range (IQR) 29–43] for OA and 36 (27–42) for RA while the median EQ-5D-3L was 0.76 (0.69–1.00) and 0.69 (0.52–0.85), respectively. After THR, the Oxford Hip Score was 42 (IQR 36–46) for OA and 39 (30–44) for RA while the EQ-5D-3L was 0.85 (0.69–1.00) and 0.69 (0.52–1.00), respectively. The estimated effect of RA, relative to OA, on post-operative scores was −0.05 (95% CI −1.57, 1.48) for the Oxford Knee Score, −0.09 (−0.13, −0.06) for the EQ-5D-3L following TKR, −1.35 (−2.93, −0.22) for the Oxford Hip Score, and −0.08 (−0.12, −0.03) for the EQ-5D-3L following THR.

Conclusion
TKR and THR led to substantial improvements in joint-specific scores and overall quality of life. While diagnosis had no clinically meaningful effect on joint-specific outcomes, improvements in general quality of life were somewhat less for those with RA, which is likely due to the systemic and multijoint nature of rheumatoid disease.

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More information

Accepted/In Press date: 1 November 2018
e-pub ahead of print date: 3 January 2019
Published date: June 2019

Identifiers

Local EPrints ID: 427722
URI: https://eprints.soton.ac.uk/id/eprint/427722
ISSN: 1462-0324
PURE UUID: 685e1e97-d2b0-43aa-9837-5668b9163361
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 25 Jan 2019 17:30
Last modified: 20 Jul 2019 01:15

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