Have the Annual Trends of Total Knee Arthroplasty in Rheumatoid Arthritis Patients Changed?

Abstract

As the use of disease modifying antirheumatic drugs have increased, it remains unclear whether or not this has affected the rates of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients. Therefore, the purpose of this study was to evaluate the annual trends of RA patients who underwent TKA. Specifically, we evaluated: (1) the annual trends of TKAs due to RA in the United States population; and (2) the annual trends in the proportion of TKAs due to RA in the United States. The Nationwide Inpatient Sample was used to identify all patients who underwent TKA between 2002 and 2013 ( = 6,492,873). Then, we identified TKA patients who had a diagnosis of RA, defined by the International Classification of Diseases, Ninth Revision (ICD-9) code 714.0. The incidence of TKAs with a diagnosis of RA in the United States was calculated using the U.S. population as the denominator. Regression models were used to analyze the annual trends of RA in patients who underwent TKA. A total of 209,332 RA patients were identified who underwent TKA. The annual prevalence of RA in patients who underwent TKA slightly increased, from 33.2 per 1,000 TKAs in 2002 to 35 per 1,000 TKAs in 2013 ( = 0.254, = 0.095). The annual number of TKAs with a diagnosis of RA increased by 93.1% from 11,618 to 22,430. After normalizing for the U.S. population, the incidence of TKAs with RA increased from 5.4 to 9.2 TKAs per 1 million U.S. adults (incidence rate ratio [IRR] = 1.05; 95% confidence interval [CI], 1.05-1.05; < 0.001). In 2002, 11,618 (3.31%) TKAs, and in 2013, 22,430 (3.50%) TKAs were due to RA. The prevalence of RA in those who underwent TKA remained the same from 2002 to 2013 (coefficient = 0.02; 95% CI, -0.01 to 0.05; = 0.095). The results of this study demonstrated that the rates of TKA performed in RA patients have remained relatively stable. Furthermore, there may have been a decline in the rate of RA patients undergoing TKA, due to an increase in the U.S. population by approximately 28.8 million during the study period.

Increasing trend of radiographic features of knee osteoarthritis in rheumatoid arthritis patients before total knee arthroplasty

“…In parallel with the raising percentage of patients treated with bDMARDs, which reportedly reached 29.5% in 2018, the remission rate based on DAS28 reached 55.9% in 2018 3 . Contrary to the study based on the Japanese database, a study using the Nationwide Inpatient Sample data from the United States showed a significant increase in TKA performed in RA patients from 2002 to 2013 although the ratio of RA to all primary diseases requiring TKA showed a steady trend 25 . Another trend study using the Nationwide Inpatient Sample data from the United States reported that the prevalence of total elbow arthroplasty and total shoulder arthroplasty in RA patients decreased by 50% and 18%, respectively, from 2002 to 2012 26 .…”

Measuring appropriate need for unicompartmental knee arthroplasty: results of the MANUKA study

“…Many authors declare such a percentage as underutilization of UKA, which in turn contributes to the higher reported UKA revision rates [9, 15]. Candidacy studies with high reported UKA candidacy do not take into account patients with rheumatoid arthritis, which is a contraindication for UKA, but is present in the daily practice [10, 17]. Even if patients with rheumatoid arthritis were to be excluded, the candidacy for UKA according to AUC criteria would increase in this study by 0.7%.…”

“…Patients with previous arthroplasty were excluded. Patients with inflammatory arthritis and with post-traumatic arthritis were not excluded, due to their presence in the daily practice of surgeons managing knee OA [ 10 , 17 ].…”

Mathematical modeling of knee arthroplasty with filling of a bone defect with implants from various materials

“…Зокрема, у США щороку виконують близько 500 тис. первинних ендопротезувань колінного суглоба [1] та 22 тис. ревізійних, що потребує значних фінансових витрат [2].…”