Rheumatoid Arthritis is Not a Contraindication to Unicompartmental Knee Arthroplasty

ABSTRACT

Background

Rheumatoid arthritis (RA) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA). However, the widespread use of disease-modifying anti-rheumatic drugs (DMARDs) has substantially improved the management of RA and prevented disease progression. The objective of this study was to ascertain whether RA impacts UKA revision-free survivorship.

Methods

Patients undergoing UKA from 2010 to 2021 were identified in an administrative claims database (n = 105,937) using Current Procedural Terminology (CPT) code 27446. All patients who underwent UKA who had a diagnosis of RA with a minimum of two-year follow-up (n = 1,422) were propensity-score matched based on age, sex, and Elixhauser Comorbidity Index (ECI) to those who did not have RA (n = 1,422). Laterality was identified using the 10th Revision of International Classification of Diseases (ICD-10) codes. The primary outcome was ipsilateral revision to total knee arthroplasty (TKA) within 2 years, and the secondary outcome was ipsilateral revision at any time.

Results

Among the 1,422 patients who had a UKA and a diagnosis of RA, 37 patients (2.6%) underwent conversion to TKA within 2 years, and 48 patients (3.4%) underwent conversion to TKA at any point. In comparison, 28 patients (2.0%) in the propensity matched control group underwent conversion to TKA within 2 years, and 40 patients (2.8%) underwent conversion to TKA at any point. Statistical analysis revealed no significant difference in conversion to TKA between patients who had and did not have RA, either within 2 years (P = 0.31) or anytime (P = 0.45).

Conclusions

Patients who had RA and underwent UKA did not have an increased risk of revision to TKA compared to those who did not have RA. This may indicate that modern management of RA could allow for expanded UKA indications for RA patients.