Total Hip Replacement in Patients with Rheumatoid Arthritis: Trends in Incidence and Complication Rates Over 35 Years

Owen Taylor-Williams; Charles A Inderjeeth; Khalid B Almutairi; Helen Keen; David B Preen; Johannes C Nossent

doi:10.1007/s40744-021-00414-9

Total Hip Replacement in Patients with Rheumatoid Arthritis: Trends in Incidence and Complication Rates Over 35 Years

Rheumatol Ther. 2022 Apr;9(2):565-580. doi: 10.1007/s40744-021-00414-9. Epub 2022 Jan 8.

Authors

Owen Taylor-Williams¹, Charles A Inderjeeth^{1

2}, Khalid B Almutairi¹, Helen Keen^{2

3}, David B Preen⁴, Johannes C Nossent^{5

6}

Affiliations

¹ Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
² Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
³ Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia.
⁴ School of Population and Global Health, University of Western Australia, Perth, WA, Australia.
⁵ Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia. johannes.nossent@uwa.edu.au.
⁶ Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia. johannes.nossent@uwa.edu.au.

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.

Keywords: Complications; Disease-modifying antirheumatic drugs; Epidemiology; Hospital records; Incidence; Rheumatoid arthritis; Total hip replacement.