Taylor-Williams Owen, Inderjeeth Charles A, Almutairi Khalid B, Keen Helen, Preen David B, Nossent Johannes C
Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Rheumatol Ther. 2022 Apr;9(2):565-580. doi: 10.1007/s40744-021-00414-9. Epub 2022 Jan 8.
Advances in rheumatoid arthritis (RA) management have made disease remission achievable. We evaluated trends in total hip replacement (THR) and postoperative outcomes in patients with RA in Western Australia (WA) over more than three decades.
This was a retrospective analysis of routinely collected prospective data from a state-wide registry containing longitudinally linked administrative health data based on International Classification of Diseases (ICD) diagnostic and procedural codes. We included patients with two or more diagnostic codes for RA (between 1980 and 2015) and studied THR incidence rates (THR IR) and complication rates (revision, peri-prosthetic fracture, infection, venous thrombosis, and mechanical loosening). Survival rates were estimated by Kaplan-Meier method and predictors analyzed by Cox regression.
We followed 9201 RA patients over 111,625 person-years, during which 1560 patients (16.9%) underwent THR. From 1985 to 2015, THR IR (per 1000 RA patient-years) decreased from 20.8 (95% CI 20.1-21.5) to 7.3 (95% CI 7.2-7.5), and 5-year THR-free survival increased from 84.3 to 95.3% (1980-2015). Ten-year prosthetic survival was 91.2%. Complication rates in the first 5 years post-THR decreased significantly from 13.1 to 3.7% (p < 0.001). Mechanical complications such as loosening and periprosthetic fracture rates decreased significantly (> 35%, P < 0.05), while infection and revision did not change over the observation period (p > 0.05).
Over the last 30 years in RA patients, THR IR and mechanical complication rates decreased significantly, but the medical complication of infection has not changed significantly.
类风湿性关节炎（RA）管理方面的进展已使疾病缓解成为可能。我们评估了西澳大利亚州（WA）超过三十年里类风湿性关节炎患者全髋关节置换术（THR）的趋势及术后结果。
这是一项对常规收集的前瞻性数据的回顾性分析，数据来自一个全州范围的登记处，该登记处包含基于国际疾病分类（ICD）诊断和程序编码的纵向关联行政健康数据。我们纳入了有两个或更多类风湿性关节炎诊断编码的患者（1980年至2015年），并研究了全髋关节置换术发病率（THR IR）和并发症发生率（翻修、假体周围骨折、感染、静脉血栓形成和机械性松动）。通过Kaplan-Meier方法估计生存率，并通过Cox回归分析预测因素。
我们在111,625人年的时间里跟踪了9201名类风湿性关节炎患者，在此期间，1560名患者（16.9%）接受了全髋关节置换术。从1985年到2015年，全髋关节置换术发病率（每1000名类风湿性关节炎患者年）从20.8（95%CI 20.1 - 21.5）降至7.3（95%CI 7.2 - 7.5），5年无全髋关节置换术生存率从84.3%提高到95.3%（1980 - 2015年）。十年假体生存率为91.2%。全髋关节置换术后前5年的并发症发生率从13.1%显著降至3.7%（p < 0.001）。机械性并发症如松动和假体周围骨折发生率显著下降（> 35%，P < 0.05），而感染和翻修在观察期内没有变化（p > 0.05）。
在过去30年里，类风湿性关节炎患者的全髋关节置换术发病率和机械性并发症发生率显著下降，但感染这一医学并发症没有显著变化。
