Bilateral knee replacement in rheumatoid arthritis can be safe but careful screening is essential

 Same-day knee replacement surgery of both knees is safe for some people with rheumatoid arthritis, according to researchers from Hospital for Special Surgery in New York.

People with rheumatoid arthritis are more likely to have conditions such as heart disease or vasculitis and may be on drugs that suppress the immune system. Surgery is therefore complicated for this group so many people with rheumatoid arthritis who need both knees replaced do so one at a time.

A new study suggest that select patients with rheumatoid arthritis do just as well with same-day bilateral knee replacement as do people with osteoarthritis, and have no higher complication rates.

Dr Mark Figgie and colleagues evaluated hospital data from 240 people with rheumatoid arthritis and 3,680 people with osteoarthritis who had bilateral knee replacement surgeries between 1998 and 2011. Those with rheumatoid arthritis were about five years younger but were more likely to be obese or have significant heart disease. Over 80%of the rheumatoid arthritis group were women.

Results showed that people with rheumatoid arthritis stayed in hospital after the operation for a little longer (5.8 days versus 5.4 days) and were more likely to have acute postoperative anaemia (17% versus 8%) and blood transfusions (84% versus 77%). They had similar rates of transfer to either the ICU or a rehabilitation facility. And there were no differences in the overall rates of procedure-related, minor and major complications between the two groups.

But Dr Figgie explains that people with rheumatoid arthritis do need to be carefully screened for surgery with stress tests:

“These are typically more challenging cases, and surgeons will want to coordinate