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Updated: Apr 13, 2026
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Rheumatoid Arthritis Does Not Increase Risk of Short-term Adverse Events after Total Knee Arthroplasty: A
Zachary J LoVerde1, Lisa A Mandl1, Beverly K Johnson1
1From the Department of Internal Medicine, The Reading Hospital and Medical Center, Reading, Pennsylvania; Department of Rheumatology, Department of Orthopedic Surgery, and Research, Hospital for Special Surgery; Albert Einstein College of Medicine; Department of Rheumatology, Jacobi Medical Center; Weill Cornell College of Medicine, New York, New York; North Central Bronx Hospital, Bronx, New York, USA.Z.J. LoVerde, MD, PGY1 Resident, Internal Medicine, The Reading Hospital and Medical Center; L.A. Mandl, MD, MPH, Assistant Professor of Research Medicine, Assistant Professor of Public Health, Weill Cornell Medicine College, and Assistant Attending Physician, Rheumatology, Hospital for Special Surgery; B.K. Johnson, MD, MS, FACR, Assistant Professor of Medicine, Albert Einstein College of Medicine, and Director of Rheumatology, Jacobi Medical Center and the North Central Bronx Hospital; M.P. Figgie, MD, Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Attending Orthopedic Surgeon, and Chief of Surgical Arthritis Service, Hospital for Special Surgery; F. Boettner, MD, Assistant Professor of Orthopedic Surgery, Weill Cornell College of Medicine, and Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery; Y. Lee, MS, Biostatistician, Hospital for Special Surgery; S.M. Goodman, MD, Associate Professor of Clinical Medicine, Weill Cornell Medicine College, and Associate Attending Physician, Rheumatology, Hospital for Special Surgery.
Rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) experienced no increase in adverse events (AE) at 6 months post-surgery. High-volume centers and experienced surgeons mitigate risks despite worse preoperative function in RA patients.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Clinical Outcomes Research
Background:
- Patients with rheumatoid arthritis (RA) historically report higher adverse events (AE) after total knee arthroplasty (TKA) compared to osteoarthritis (OA) patients.
- Contemporary RA cohorts and high-volume surgical centers may alter this risk profile.
- Understanding postoperative AE in RA patients is crucial for optimizing surgical management.
Purpose of the Study:
- To evaluate 6-month postoperative adverse events (AE) in rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA).
- To compare AE rates between RA and osteoarthritis (OA) patients in a contemporary, high-volume center setting.
- To assess the impact of RA-specific surgical volume on postoperative outcomes.
Main Methods:
- Retrospective analysis of RA patients from an institutional registry (2007-2010).
- Matching RA patients to two osteoarthritis (OA) patients by age, sex, and procedure.
- AE identification through self-report and chart review; comparison of baseline characteristics and outcomes.
Main Results:
- No significant difference in deep infection, superficial infection, myocardial infarction, or thromboembolism rates between RA and OA groups.
- RA patients exhibited worse baseline pain, function, and perceived health status (EQ-5D) preoperatively.
- High RA-specific surgical volume was observed, with 64% of cases performed by surgeons with ≥ 20 RA cases.
Conclusions:
- In a high-volume center with substantial RA-specific surgical experience, rheumatoid arthritis does not appear to increase postoperative adverse events after TKA.
- Despite poorer preoperative function and significant use of corticosteroids and disease-modifying antirheumatic drugs (DMARDs), complication rates were not elevated in RA patients.
- Further research is needed to confirm the generalizability of these findings across different healthcare settings.
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