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The impact of rheumatoid arthritis on the risk of adverse events following joint replacement: a real-world cohort study

The impact of rheumatoid arthritis on the risk of adverse events following joint replacement: a real-world cohort study
The impact of rheumatoid arthritis on the risk of adverse events following joint replacement: a real-world cohort study

Purpose: To assess whether rheumatoid arthritis (RA) is associated with a greater risk of adverse events following total knee replacement (TKR) and total hip replacement (THR) than osteoarthritis (OA). Patients and methods: Individuals with a diagnosis of RA or OA were identified using primary care records. TKR and THR following diagnosis were identified using linked hospital records. Myocardial infarction (MI), prosthetic joint infection (PJI), venous thromboembolism (VTE), and death were identified within 90 days following surgery, and revision procedures over 10 years following surgery. The impact of RA compared to OA on the risk for these adverse events was assessed using Cox proportional hazard models. Univariable models, with diagnosis as the only explanatory variable, and multivariable models, with age, gender, and year of surgery first added and then a measure of other comorbidities also included, were estimated. Results: In all 20,763 individuals, with 10,260 TKR and 10,961 THR, were included in the analysis. Compared to those with OA, individuals with a diagnosis of RA had a greater incidence of MI over 90 days following TKR (OA: 0.28%, RA: 0.75%) and revision over 10 years following THR (OA: 5.55%, RA: 8.68%). Both of these differences were statistically significant with, for example, hazard ratios of 3.54 (1.44 to 8.73) for MI and 1.61 (1.06 to 2.46) for revision after controlling for age, gender, year of surgery, and other comorbidities. Conclusion: These findings suggest that, compared to individuals with OA, those with RA have an increased short-term risk of MI following TKR. While risk of MI remains below 1%, this does underline the importance of the management of cardiovascular risk factors for those with RA. RA was also associated with an increased long-term risk of revision following THR, which strengthens the argument for investing in therapies which may prevent the need for joint replacement.

Arthroplasty, Hip, Knee, Osteoarthritis, Surgery
1179-1349
697-704
Burn, Edward
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Edwards, Christopher J.
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Murray, David W.
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Silman, Alan
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Cooper, Cyrus
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Arden, Nigel K.
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Prieto-Alhambra, Daniel
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Pinedo-Villanueva, Rafael
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Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Edwards, Christopher J.
dcb27fec-75ea-4575-a844-3588bcf14106
Murray, David W.
fa0e1764-e600-42bd-937d-6d7e5d623bbc
Silman, Alan
1ab1fc13-51f5-44c8-92f1-0bb32a5c5754
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131

Burn, Edward, Edwards, Christopher J., Murray, David W., Silman, Alan, Cooper, Cyrus, Arden, Nigel K., Prieto-Alhambra, Daniel and Pinedo-Villanueva, Rafael (2018) The impact of rheumatoid arthritis on the risk of adverse events following joint replacement: a real-world cohort study. Clinical Epidemiology, 10, 697-704. (doi:10.2147/CLEP.S160347).

Record type: Article

Abstract

Purpose: To assess whether rheumatoid arthritis (RA) is associated with a greater risk of adverse events following total knee replacement (TKR) and total hip replacement (THR) than osteoarthritis (OA). Patients and methods: Individuals with a diagnosis of RA or OA were identified using primary care records. TKR and THR following diagnosis were identified using linked hospital records. Myocardial infarction (MI), prosthetic joint infection (PJI), venous thromboembolism (VTE), and death were identified within 90 days following surgery, and revision procedures over 10 years following surgery. The impact of RA compared to OA on the risk for these adverse events was assessed using Cox proportional hazard models. Univariable models, with diagnosis as the only explanatory variable, and multivariable models, with age, gender, and year of surgery first added and then a measure of other comorbidities also included, were estimated. Results: In all 20,763 individuals, with 10,260 TKR and 10,961 THR, were included in the analysis. Compared to those with OA, individuals with a diagnosis of RA had a greater incidence of MI over 90 days following TKR (OA: 0.28%, RA: 0.75%) and revision over 10 years following THR (OA: 5.55%, RA: 8.68%). Both of these differences were statistically significant with, for example, hazard ratios of 3.54 (1.44 to 8.73) for MI and 1.61 (1.06 to 2.46) for revision after controlling for age, gender, year of surgery, and other comorbidities. Conclusion: These findings suggest that, compared to individuals with OA, those with RA have an increased short-term risk of MI following TKR. While risk of MI remains below 1%, this does underline the importance of the management of cardiovascular risk factors for those with RA. RA was also associated with an increased long-term risk of revision following THR, which strengthens the argument for investing in therapies which may prevent the need for joint replacement.

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Accepted/In Press date: 23 February 2018
e-pub ahead of print date: 14 June 2018
Published date: 14 June 2018
Keywords: Arthroplasty, Hip, Knee, Osteoarthritis, Surgery

Identifiers

Local EPrints ID: 424806
URI: https://eprints.soton.ac.uk/id/eprint/424806
ISSN: 1179-1349
PURE UUID: 6269c731-ab97-4c88-a806-dd900ced96d8
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 05 Oct 2018 11:47
Last modified: 10 Dec 2019 01:53

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