Outcomes in patients with rheumatoid versus osteoarthritis for total hip arthroplasty: A meta-analysis and systematic review

Abstract

Objective: Total hip arthroplasty(THA) in patients with osteoarthritis(OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare rates of THA complications in patients with RA versus OA.

Methods: The PUBMED, EMBASE, and Cochrane Library databases were searched for all available studies comparing the outcomes of THA in RA and OA patients. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Meta-analysis was performed using Stata 12.0 software.

Results: Twenty-three studies with a total of 877,695 patients were included. Results showed that patients in the RA group were more likely to have revision (OR=1.15, 95% CI, 1.02-1.29; P = 0.019), hip dislocation (OR=2.31, 95% CI, 1.67-3.20; P<0.01), periprosthetic infection (OR=1.44, 95% CI, 1.29-1.61; P<0.01), wound infection (OR=2.15, 95% CI, 1.19-3.90; P = 0.01), and revision for late infection (ES=1.71, 95% CI, 0.54-1.80; P<0.01) than those in the OA group. Subgroup analysis showed no significant difference in revision rates (OR=1.12, 95%CI, 0.94-1.31; P = 0.21) between the two groups in studies published before 2010, while studies published after 2010 showed significantly higher revision rates (OR=1.15, 95%CI, 1.02-1.30; P = 0.04) in the RA group. There were no significant differences in mortality (OR=1.20,95% CI, 0.89-1.61; P = 0.23), deep vein thrombosis (OR=0.52, 95% CI, 0.12-2.34; P = 0.40) between the groups. THA can improve the function and reduce pain of patients with RA.

Conclusion: Our study indicated that compared with OA, patients with RA are at higher risk of complications after THA. But THA can relieve pain, improve function and the quality of life of patients with RA, and did not increase mortality risk. Therefore, THA can be used as a treatment option for RA patients who failed to respond to conservative treatment. Patients should be fully informed of the benefits and possible risks of surgery, individualized treatment strategy should be made.

Keywords: Meta-analysis; Osteoarthritis; Rheumatoid arthritis; Total hip arthroplasty.