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Effect of rheumatoid arthritis on primary total knee arthroplasty and revision arthroplasty by Wooseong Jeong1,2, Oh-Sung
Kwon3, Sung Wook Song4 (1Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of
Korea; 2Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea; 3Department of Medical
Information, Jeju National University Hospital, Jeju, Republic of Korea; 4Department of Emergency Medicine, Jeju National
University College of Medicine, Jeju, Republic of Korea)
Abstract The demand for total knee arthroplasty (TKA) is rapidly increasing Received: February 9, 2023
Revised : February 25, 2023
worldwide. The most common indication for TKA is osteoarthritis (OA); however, Accepted : March 3, 2023
some patients with rheumatoid arthritis (RA) also undergo TKA. This study aimed
to investigate the effects of RA on TKA. Our findings revealed that patients with Correspondence to
Sung Wook Song
RA underwent TKA at a younger age than did patients with OA. However, contrary Department of Emergency Medicine, Jeju
to the findings of pre-21st century studies, the average age of TKA among patients National University College of Medicine,
with RA was not significantly different from that of patients with OA. Additionally, 15 Aran 13-gil, Jeju 63241, Republic of
Korea
patients with RA had a 1.5-fold higher risk of undergoing TKA. Although not Tel: 82-64-717-8000
statistically significant, patients with RA had a higher revision TKA rate, a shorter Fax: 82-64-717-2833
time until revision TKA, and underwent more revision TKAs due to infections than E-mail: sungwook78@jejunu.ac.kr
did patients with OA. An analysis of factors that affect revision TKA revealed that
the risk of revision increased if the erythrocyte sedimentation rate and C-reactive
protein levels were increased at the time of TKA. This study showed that patients
with RA have a slightly higher risk of undergoing TKA than did patients with OA.
Furthermore, the presence of inflammation at the time of TKA increases the
risk of revision; therefore, inflammation should be adequately controlled before
performing TKA.
https://medsci.jejunu.ac.kr/ 33
Journal of Medicine and Life Science Vol. 20, No. 1, March 2023
원인으로 슬관절재치환술을 받은 환자는 poly ethylene wear가 자군에서 슬관절재치환술을 하게 된 원인은 감염이 5명(55.6%)로
원인인 환자 15명(9%), femoral condyle fracture가 원인인 환 가장 많았고 그 다음으로 loosening 2명(22.2%), poly ethylene
자 3명(1.8%)이 있었다. wear 1명(11.1%), femoral condyle fracture 1명(11.1%) 순이었
RA 환자와 OA 환자 두 군으로 나누어 분석하였을 때 RA 환자 다. 슬관절치환술을 받을 당시 시행한 혈액검사에서 적혈구침강속
가 OA 환자에 비해 유의하게 더 젊은 나이에 슬관절치환술을 받 도(43.8±31.7 mm/h vs. 26.6±22.6 mm/h, P<0.001)와 C-re-
았고(69.6±6.8세 vs. 72.5±6.4세, P<0.001) 여성의 비율이 높았 active protein (1.8±2.3 mg/dL vs. 0.8±2.1 mg/dL, P<0.001)
다(91.9% vs. 85.5%, P = 0.031). 통계적으로 유의하지는 않았지만 은 RA 환자군이 OA 환자군보다 유의하게 높았다(Table 1).
슬관절재치환술을 받은 환자의 비율은 RA 환자군에서 더 많았고 슬관절치환술을 받게 되는 빈도는 RA 환자군은 10만 인년당
(5.6% vs. 3.1%, P =0.068) 슬관절치환술을 받고 슬관절재치환술 1,436.0회로 OA 환자군(10만 인년당 1,379.3회)보다 더 높았다
을 받기까지 기간의 평균 기간은 RA 환자군에서 더 짧았다(33.8± (Table 2). RA 환자군이 OA 환자군에 비해 더 젊은 나이에 슬
49.2개월 vs. 67.7±56.1개월, P =0.078). 슬관절재치환술을 하게 관절치환술을 받기 시작했고(Fig. 1), 성별을 보정하여 일생 동
된 원인은 OA 환자군에서는 loosening이 73명(46.2%)으로 가장 안 슬관절치환술을 받게 되는 위험을 비교했을 때 RA 환자군이
많았고 그 다음은 감염 69명(43.7%), poly ethylene wear 14명 OA 환자군에 비해 유의하게 슬관절치환술을 받을 위험이 높았
(8.9%), femoral condyle fracture 2명(1.3%) 순이었다. RA 환 다(hazard ratio [HR], 1.485; 95% confidence interval [CI],
34 https://medsci.jejunu.ac.kr/
정우성, 권오성, 송성욱 Effects of RA on arthroplasty
Table 3. Adjusted hazard ratio for total knee arthroplasty with rheumatoid arthritis versus osteoarthritis
Characteristic Hazard ratio P-value 95% CI
Osteoarthritis Reference
Rheumatoid arthritis 1.485 1.269–1.739 <0.001
P<0.05 considered significant. Adjusted for gender.
CI: confidence interval.
Table 4. Multiple logistic regression analysis for the risk factors of revision knee arthroplasty
Charateristic Odds ratio 95% CI P-value
Age 0.91 0.89–0.93 <0.001
ESR 1.02 1.01–1.03 <0.001
CRP 1.11 1.06–1.16 <0.001
RA 0.97 0.43–1.93 0.933
P<0.05 considered significant.
CI: confidence interval, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, RA: rheumatoid arthritis.
https://medsci.jejunu.ac.kr/ 35
Journal of Medicine and Life Science Vol. 20, No. 1, March 2023
36 https://medsci.jejunu.ac.kr/
정우성, 권오성, 송성욱 Effects of RA on arthroplasty
https://medsci.jejunu.ac.kr/ 37