A Population Based Assessment of the Use of Orthopedic Surgery in Patients with RA

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A Population Based Assessment of the Use of Orthopedic Surgery in

Patients with Rheumatoid Arthritis

LORETO MASSARDO, SHERINE E. GABRIEL, CYNTHIA S. CROWSON, W. MICHAEL

O'FALLON, and ERIC L. MATTESON

ABSTRACT.

Objective. To describe the use of orthopedic surgery, including joint

replacement surgery, in a well defined population based cohort of

patients with rheumatoid arthritis (RA) and to identify characteristics

that predict such use.

Methods. A retrospective medical record review was performed of cases of

RA incident in Rochester, MN, during the years 1955-85. Patients were

followed until 1998. All joint surgeries were recorded, including joint

reconstructive surgeries, total joint arthroplasty (TJA), and other

joint reconstructive procedures (JRP) such as tendon transfers and

resections, joint fusions, and surgeries for fractures and infections

involving joints.

Results. Of the total 424 RA incident cases, 148 (34.9%) patients

underwent one or more (maximum of 20/patient) surgical procedures

involving joints during their followup (median 14.8 yrs, range 0.2-42.8

yrs). Overall, this RA cohort had 9.7 surgeries per 100 person-yrs of

followup. The estimated cumulative incidence of surgical procedures for

RA at 30 yrs was 52.7% ± SE 4.2. Surgeries for arthritis related joint

disease of RA included: primary TJA 76 patients (31.3 ± 4.1); JRP joint

fusion 78 patients (29.4 ± 3.5); JRP soft tissue 92 patients (29.8 ±

3.3); and cervical spine fusion one patient. Non-RA (trauma and other)

joint surgeries included TJA 26 patients (13.5 ± 3.4) and arthrotomy for

septic arthritis 8 patients (2.4 ± 0.9). Based on proportional

hazards regression, the risk of having a disease related joint surgery

for RA is increased in patients who are younger (p < 0.001), have

positive rheumatoid factor (p = 0.01), and those with rheumatoid nodules

(p < 0.001). There was a borderline significant increase in the risk of

first joint surgery in women (p = 0.09). Women also had significantly

more joint surgeries (11.5/100 person-yrs) than men (4.9/100 person-yrs;

p < 0.001). Survival of patients who had surgery for RA related joint

disease was similar to those who did not.

Conclusion. This is the first population based assessment of joint

surgeries performed in patients with RA. Reconstructive surgeries were

common, and women had significantly more surgeries than men.

Survivorship among patients with RA undergoing surgeries was similar to

that of the RA patient population at large. (J Rheumatol 2002;29:52-6)