A comparison of perioperative outcomes in patients with and without rheumatoid arthritis after receiving a total shoulder replacement arthroplasty.

HYPOTHESIS: The long-term survival rate of total shoulder arthroplasty (TSA) is comparable to hip and knee arthroplasty. Although TSA is considered a safe and effective procedure with low complications in patients with osteoarthritis and rheumatoid arthritis (RA), data are lacking on perioperative complications. Complication rates and hospital disposition differences between patients with and without RA who underwent TSA were investigated. We hypothesized that RA patients would have poorer perioperative outcomes after TSA. MATERIALS AND METHODS: Data from the Nationwide Inpatient Sample was used to capture 25,398 patients between 1988 and 2005 who underwent TSA. Of these, 1,186 patients had a primary diagnosis of RA and were compared with 24,212 patients without RA. Analyses addressed perioperative complications and hospital disposition factors using bivariate and logistic regression models. RESULTS: Overall complication rates were exceptionally low in both groups. Hospital disposition factors were significantly different between the 2 groups. The RA cohort had shorter average lengths of stay, higher likelihood of routine discharge, and lower inflation-adjusted cost before and after adjustment for covariates. DISCUSSION: The occurrence of complications in the perioperative setting was less than 1% for both study groups in most variables investigated, and there were only minimal differences in perioperative complications between the groups. The significant differences in hospital disposition factors suggest that patients with RA may have less complex hospital stays and may be more comfortable being discharged under their own care. Recent studies describing the overall improvement in the management of patients with RA may also help explain these findings. CONCLUSIONS: The findings suggest that the perioperative complications of a total shoulder replacement for patients with and without RA are similar. Contrary to our expectations, TSA patients with RA had shorter and less costly hospital stays and were more likely to have routine discharge. Complications are likely more long-term in nature than detected in this study and require longer follow-up beyond perioperative periods for fruition.

A comparative assessment of alignment angle of the knee by radiographic and physical examination methods.

OBJECTIVE: To compare the knee-alignment angle from a full-limb radiograph (mechanical axis) with the anatomic-axis angle as measured by physical examination using a goniometer and by 2 other radiographic methods. METHODS: The knee-alignment angle was measured in 114 knees of 57 subjects who had radiographic osteoarthritis (OA), with a Kellgren/Lawrence grade of >/=1 in at least one knee. The mechanical axis was defined as the angle formed by the intersection of 2 lines, one from the center of the head of the femur to the center of the tibial spines, and a second from the center of the talus to the center of the tibial spines. The anatomic axis was defined as the angle formed by 2 lines, each originating from a point bisecting the femur and tibia and converging at the center of the tibial spine tips. The anatomic-axis angle was measured by 3 methods: 1) physical examination using a goniometer, 2) a posteroanterior (PA) fixed-flexion knee radiograph (anatomic(PA) axis), and 3) an anteroposterior (AP) full-limb radiograph (anatomic(AP) axis). RESULTS: Significant correlations were found between the mechanical-axis angle and the anatomic-axis angle measured by each of the 3 methods: by goniometer (r = 0.70, P < 0.0001), by anatomic(PA) axis (r = 0.75, P < 0.0001), and by anatomic(AP) axis (r = 0.65, P < 0.0001). The anatomic axis was offset a mean 4.21 degrees valgus from the mechanical axis (3.5 degrees in women, 6.4 degrees in men), which was consistent across all methods. CONCLUSION: Knee alignment assessed clinically by goniometer or measured on a knee radiograph is correlated with the angle measured on the more cumbersome and costly full-limb radiograph. These alternative measures have the potential to provide useful information regarding the risk of progression of knee OA when a full-limb radiograph is not available.