Nettrour John F, Bailey Bradley S, Burch Major B, Clair Devin D, June Rayford R, Olsen Nancy J, Ba Djibril M, Liu Guodong, Leslie Douglas L
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
Arthroplast Today. 2021 Mar 10;8:118-123. doi: 10.1016/j.artd.2021.02.002. eCollection 2021 Apr.
For 20 years, authors have predicted an expansion in total knee arthroplasty (TKA) and total hip arthroplasty (THA) utilization. Over this same period, the introduction of biological disease-modifying antirheumatic drugs has dramatically altered the treatment of rheumatoid arthritis (RA) with hopes of preventing articular damage and obviating the need for prosthetic replacement. The goal of our investigation was to evaluate TKA and THA utilization in young patients with RA (<65 years) in 2005 vs 2014 compared to patients with osteoarthritis (OA).
Using relevant International Classification of Disease Ninth Revision (ICD-9) and Current Procedural Terminology codes, the Truven MarketScan Database (over 46 million enrollees) was queried to determine THA and TKA incidence rates for RA and OA patients aged <65 years during the final decade of ICD-9 use. Patients with potentially confounding ICD-9 codes were excluded to limit coding variation. Statistical analysis consisted of student -tests, Pearson's chi-square tests, and Breslow-Day tests.
For patients with OA, TKAs increased substantially from 0.07% in 2005 to 0.1% in 2014 (+42.9% change, < .001). Similarly for patients with OA, THAs increased from 0.04% to 0.06% over the same time period (+66.0% change, < .001). For young patients with RA, the rate of TKA remained relatively stable-1.06% in 2005 to 1.04% in 2014 (-1.7% change, = .65)-as did THA-0.44% to 0.48% (+9.0% change, = .14).
Dramatic increases in THA and TKA rates for OA patients aged <65 years were indeed observed from 2005 to 2014. This trend, however, was not seen in the RA population where TKA and THA rates remained unchanged.
20年来，作者们一直预测全膝关节置换术（TKA）和全髋关节置换术（THA）的使用将会增加。在同一时期，生物性疾病改善抗风湿药物的引入极大地改变了类风湿关节炎（RA）的治疗方式，有望预防关节损伤并避免进行假体置换。我们研究的目的是评估2005年与2014年相比，年轻RA患者（<65岁）与骨关节炎（OA）患者的TKA和THA使用情况。
使用相关的国际疾病分类第九版（ICD-9）和当前手术操作术语编码，查询Truven MarketScan数据库（超过4600万参保者），以确定在使用ICD-9的最后十年中，年龄<65岁的RA和OA患者的THA和TKA发病率。排除具有潜在混淆ICD-9编码的患者以限制编码差异。统计分析包括学生t检验、Pearson卡方检验和Breslow-Day检验。
对于OA患者，TKA从2005年的0.07%大幅增加到2014年的0.1%（变化+42.9%，P<.001）。同样，对于OA患者，THA在同一时期从0.04%增加到0.06%（变化+66.0%，P<.001）。对于年轻的RA患者，TKA的发生率保持相对稳定——从2005年的1.06%降至2014年的1.04%（变化-1.7%，P=.65），THA也是如此——从0.44%升至0.48%（变化+9.0%，P=.14）。
确实观察到2005年至2014年期间，年龄<65岁的OA患者的THA和TKA发生率大幅增加。然而，在RA人群中未观察到这种趋势，其TKA和THA发生率保持不变。
