TY - JOUR
T1 - Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis
T2 - A Systematic Review and Meta-Analysis Across Four Decades
AU - Taylor-Williams, Owen
AU - Nossent, Johannes
AU - Inderjeeth, Charles A.
PY - 2020/12
Y1 - 2020/12
N2 - Introduction Over the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades. Methods This is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE, Scopus, and Cochrane between January 1, 1980 and December 31, 2019. Results The search retrieved 1715 articles of which 44 were included for quantitative synthesis. The rate for THA decreased by almost 40% from 11/1000 patient years (PY) in the 2000s to 7/1000 PY in the 2010s, while the overall complication rate decreased from 9.9% in the 1990s to 5.3% in the 2010s. Throughout the duration of the study, THA incidence and overall complication rate decreased. However, not all individual complication rates decreased. For example, revision and periprosthetic fracture decreased, infection and aseptic loosening remained constant, and dislocation increased. Conclusion Medical management of patients with RA has reduced the need for THA, while postoperative medical and surgical management has improved some postoperative outcomes. Nevertheless, there remains room for further improvement to postoperative outcomes through RA-specific management.
AB - Introduction Over the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades. Methods This is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE, Scopus, and Cochrane between January 1, 1980 and December 31, 2019. Results The search retrieved 1715 articles of which 44 were included for quantitative synthesis. The rate for THA decreased by almost 40% from 11/1000 patient years (PY) in the 2000s to 7/1000 PY in the 2010s, while the overall complication rate decreased from 9.9% in the 1990s to 5.3% in the 2010s. Throughout the duration of the study, THA incidence and overall complication rate decreased. However, not all individual complication rates decreased. For example, revision and periprosthetic fracture decreased, infection and aseptic loosening remained constant, and dislocation increased. Conclusion Medical management of patients with RA has reduced the need for THA, while postoperative medical and surgical management has improved some postoperative outcomes. Nevertheless, there remains room for further improvement to postoperative outcomes through RA-specific management.
KW - Complications
KW - Disease-modifying antirheumatic drugs
KW - Incidence
KW - Rheumatoid arthritis
KW - Systematic review
KW - Total hip arthroplasty
KW - MODIFYING ANTIRHEUMATIC DRUGS
KW - JOINT REPLACEMENT SURGERY
KW - THRUST PLATE PROSTHESIS
KW - TOTAL KNEE ARTHROPLASTY
KW - REVISION TOTAL HIP
KW - ORTHOPEDIC-SURGERY
KW - FOLLOW-UP
KW - PREDICTIVE FACTORS
KW - AMERICAN-COLLEGE
KW - RISK-FACTORS
U2 - 10.1007/s40744-020-00238-z
DO - 10.1007/s40744-020-00238-z
M3 - Review article
C2 - 33000421
SN - 2198-6576
VL - 7
SP - 685
EP - 702
JO - Rheumatology and therapy
JF - Rheumatology and therapy
IS - 4
ER -