Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analys

  • PDF / 1,106,137 Bytes
  • 18 Pages / 595.276 x 790.866 pts Page_size
  • 59 Downloads / 193 Views

DOWNLOAD

REPORT


REVIEW

Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades Owen Taylor-Williams

. Johannes Nossent . Charles A. Inderjeeth

Received: August 20, 2020 / Accepted: September 19, 2020 Ó The Author(s) 2020

ABSTRACT 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.

Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12967229. Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s40744020-00238-z) contains supplementary material, which is available to authorized users. O. Taylor-Williams  J. Nossent (&)  C. A. Inderjeeth (&) School of Medicine, The University of Western Australia, Perth, Australia e-mail: [email protected] C. A. Inderjeeth e-mail: [email protected] J. Nossent  C. A. Inderjeeth Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia

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. Keywords: Complications; Disease-modifying antirheumatic drugs; Incidence; Rheumatoid arthritis; Systematic review; Total hip arthroplasty

Rheumatol Ther

Key Summary Points This systematic review analysed published literature on total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) to estimate the incidence of THA and postoperative outcomes (revision, periprosthetic fracture, infection, aseptic loosening, dislocation, venous thromboembolism (VTE), and mortality) in patients with RA throughout the past four decades. Medical management has resulted in a decreasing incidence of THA in patients with RA, while surgical and medical management has improve