Total Joint Arthroplasty in Patients With Rheumatoid Arthritis: A United States Experience From 1992 Through 2005

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Abstract

To determine whether total joint arthroplasty (TJA) for patients with rheumatoid arthritis (RA) is decreasing, we collected Nationwide Inpatient Sample database information (1992 through 2005) on (1) the number of primary TJAs for all patient diagnoses, (2) the number of primary TJAs for patients with RA, and (3) distribution of age and sex in both groups. To account for population growth, a given year's arthroplasty estimate was normalized against its population. The trends over time were analyzed using a multivariable Poisson regression model (significance, P < .05). We found that the number of primary TJA procedures increased in the general and RA populations but that, after adjusting for population growth, age, and sex, the rate was significantly lower in patients with RA.

Section snippets

Data Source

Maintained by the Agency for Healthcare Research and Quality [17], the NIS is the largest all-payer, inpatient care, stratified survey of US hospitals [17]. It contains a representative 20% sample of hospitals and tracks approximately 8 million hospital stays each year. The hospitals within the sampling frame are stratified according to region, location, teaching status, and number of beds. All discharge records from each of the selected hospitals are collected each year. For example, in 2007,

Total Knee Arthroplasty

There were 4 164 465 hospitalizations associated with primary TKA, 153 501 (3.7%) of which were associated with a diagnosis of RA (Table 1). The number of cases of primary TKA increased over time in the general population and in patients with RA (Fig. 1, Fig. 2). The incidence of primary TKA was significantly lower among those with RA than in the general population (P < .0001). In all patients, the incidence of primary TKA was significantly higher in females than in males (P < .0001) and

Discussion

In the United States, although the absolute number of primary TJA procedures from 1992 through 2005 increased in both the general population and in the patients with RA, the population-adjusted rates of these procedures were significantly lower in patients with RA. This finding has several important implications.

Studies from Sweden have reported a decrease in lower limb procedures in patients with RA between 1987 and 2001 [13] and a decrease in upper limb procedures between 1998 and 2004 [12].

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    The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.12.027.

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