Patient-Reported Outcomes and Satisfaction Following Total Knee Arthroplasty in Rheumatoid Arthritis: An Observational Cohort Study.

Abstract

Advances in pharmacologic therapy for rheumatoid arthritis (RA), including biologics and Janus kinase inhibitors, have reduced joint damage and the need for surgery. However, total knee arthroplasty (TKA) remains essential in patients who have RA and are generally favorable; most studies emphasize physician-reported outcomes, with limited focus on patient-reported outcome measures (PROMs). We retrospectively reviewed 61 patients who have RA (61 knees) who underwent primary TKA between June 2018 and June 2023. Clinical outcomes were assessed using range of motion (ROM), Japanese Orthopaedic Association (JOA) score, and Knee Society Score (KSS). The PROMs included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a five-grade satisfaction scale. Patients were categorized as satisfied or dissatisfied for subgroup analysis. The ROM improved significantly from -10.1 to 112.9° preoperatively to -1.8 to 118.3° postoperatively. The JOA scores increased from 50.0 to 65.6, and both KSS knee and functional scores improved significantly (P < 0.01). All KOOS domains improved, with 85.2% of patients reporting satisfaction. In subgroup analysis, physician-reported scores did not differ significantly between satisfied and dissatisfied groups, whereas KOOS ADL and quality of life (QOL) subscales showed greater improvement among satisfied patients. Total knee arthroplasty in patients who have RA yields significant improvement in physician- and patient-reported outcomes. Improvements in PROMs, particularly in activities of daily living and QOL domains, show a closer association with postoperative satisfaction than clinician-based measures. These findings highlight the importance of routinely incorporating PROMs into outcome evaluation after TKA in RA.