Background/Purpose: The purpose of this study was to analyze time-trends in various types of total joint arthroplasty (TJA) and assess if the proportion of the procedures performed on patients with RA has changed over time.

Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002 to 2012 to identify the number of patients per year undergoing TJA of the shoulder (TSA), elbow (TEA), knee (TKA), hip (THA), and ankle (TAA). We determined the proportion of these patients with a diagnosis of RA. Consistent with the design of the NIS, sampling weights were applied to obtain national estimates. Population-based rates of TJA were calculated using population estimates from the U.S. Census Bureau.

Results: During the study period, the overall utilization of TJA increased by 64.7% while the prevalence of comorbid RA in all TJA increased 0.1%. However, when stratified by specific joint, the prevalence of RA in patients undergoing TJA significantly decreased (p < 0.05) by 12% for TEA and 0.9% for TSA, decreased 4.6% (p = 0.06) for TAA, while there were increases of 0.2% for THA and 0.1% for TKA.

Conclusion: While the incidence of TJA is increasing nationally, the epidemiological landscape of TSA, TEA, and TAA performed in the RA population has varied. Such findings may be evidence of the successful early implementation of biological DMARD therapy and/or adoption of aggressive treatment strategies using combinations of traditional and biological DMARDs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/trends-in-joint-replacement-surgery-in-patients-with-rheumatoid-arthritis/