Dr. Goodman says the study doesn’t explain why there are differences between the OA and RA patients getting hip replacements. She speculates that RA hip replacement patients may be putting off the surgery too long (as evidenced by their poor pre-operative function).

Dr. Goodman points to another interesting factor: Researchers found that patients who expected that they would do well with surgery were in fact more likely to do well and less likely to report bad pain and function scores.

“Having poor function was less of a predictor of your outcome than feeling like you can do well, which I think is fascinating,” Dr. Goodman explains. “The message there is we really need to talk to our patients about what they can expect from a single joint [replacement]. I think patients who go into this with a good attitude and patients who have spoken to their doctors and have a good plan for their rehabilitation and keep their RA under good control – they probably will do as well as OA patients.”

Dr. Goodman says the bottom line for RA patients is that joint replacements are an important and effective surgery.

“We have no evidence RA patients have more adverse events. They do improve significantly and they are very satisfied with the outcomes – they just aren’t hitting the mark the OA patients are,” Dr. Goodman says. “Absolutely get the knees done when you meet the criteria and watch the hips carefully. It may be you are waiting too long. The timing of the surgery might be a place to look when it comes to what we can do differently.”

Eric L. Matteson, MD, chair of the rheumatology department at the Mayo Clinic in Rochester, Minn., agrees this study confirms the benefits of joint replacements – no matter your underlying condition. “Whether you have RA or OA, you have a very significant improvement in your pain and in your function after having the surgery. I think that is the biggest take-home message there is. That is true for the knee and hip surgeries.”

He says though it’s not clear why a higher number of patients with RA are not as satisfied with hip replacements as OA patients, it’s important to stress that those who are unsatisfied make up a small minority of patients: 87 percent of RA patients having a first time knee replacement and 89 percent having a first time hip replacement were satisfied overall.

“So I think that is still really good,” Dr. Matteson says.

He also wonders if higher expectations are playing a role, given the fact that patients these days have come to expect less disability and better function as a result of new medications. “Today with the drugs we use, patients’ expectations are much higher … When they have surgery they want to be as close to normal as they can be. That’s not actually examined here but I think that is something we are seeing today,” Dr. Matteson says.

Dr. Matteson says it’s critical for patients to talk with their doctor before surgery to understand what procedures will do for them. “You have to understand realistically what benefits there will be and that’s something that requires a discussion with a physician,” he says. “It may be there are certain characteristics people have, [such as] depression, that could affect their outcomes. Those things need to be taken into account as patients are counseled for surgery.”