Authors: Owen Taylor-Williams, Charles A. Inderjeeth, Khalid B. Almutairi, Helen Keen, David B. Preen & Johannes C. Nossen
Abstract
Introduction
Advances in rheumatoid arthritis (RA) management have made disease remission achievable. We evaluated trends in total hip replacement (THR) and postoperative outcomes in patients with RA in Western Australia (WA) over more than three decades.
Methods
This was a retrospective analysis of routinely collected prospective data from a state-wide registry containing longitudinally linked administrative health data based on International Classification of Diseases (ICD) diagnostic and procedural codes. We included patients with two or more diagnostic codes for RA (between 1980 and 2015) and studied THR incidence rates (THR IR) and complication rates (revision, peri-prosthetic fracture, infection, venous thrombosis, and mechanical loosening). Survival rates were estimated by Kaplan–Meier method and predictors analyzed by Cox regression.
Results
We followed 9201 RA patients over 111,625 person-years, during which 1560 patients (16.9%) underwent THR. From 1985 to 2015, THR IR (per 1000 RA patient-years) decreased from 20.8 (95% CI 20.1–21.5) to 7.3 (95% CI 7.2–7.5), and 5-year THR-free survival increased from 84.3 to 95.3% (1980–2015). Ten-year prosthetic survival was 91.2%. Complication rates in the first 5 years post-THR decreased significantly from 13.1 to 3.7% (p < 0.001). Mechanical complications such as loosening and periprosthetic fracture rates decreased significantly (> 35%, P < 0.05), while infection and revision did not change over the observation period (p > 0.05).
Conclusions
Over the last 30 years in RA patients, THR IR and mechanical complication rates decreased significantly, but the medical complication of infection has not changed significantly.
Key Summary Points |
Background: Improved management of rheumatoid arthritis (RA) over the last decades has made disease remission an achievable goal |
Hypothesis: The need for total hip replacement (THR) and the rate of post-operative complication rates in RA patients has decreased over the last decades. |
Conclusions: In Australian RA patients, THR incidence rates decreased significantly over time and well before the introduction of bDMARDs. Rates for mechanical post-operative complications (aseptic loosening and periprosthetic fracture) decreased, while infection rates remain unchanged. |
What was learned: More aggressive RA treatment with csDMARD over the last decades has been associated with a more than 50% decrease in the need for THR in RA. Whether increased use of bDMARDs further reduces the need for THR and rate of postoperative complications remains to be elucidated. |