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The Effects of Disease-Modifying Anti-Rheumatic Drugs on Total Hip Arthroplasty Outcomes in Patients Who Have
Nigam Sheth1, Bailey J Ross1, Bryce Hrudka2
1Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.
Background:
Disease-modifying anti-rheumatic drugs (DMARDs) are essential in managing inflammatory arthritides such as rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis. As total hip arthroplasty (THA) and DMARD use become more common, it is unclear how DMARD use affects outcomes in this population. This study compared complications and implant survivorship after THA in patients who have inflammatory arthritis who had and did not have DMARD treatment.
Methods:
A retrospective matched cohort study was performed using a national claims database. Patients who had rheumatoid arthritis, psoriatic arthritis, or juvenile idiopathic arthritis undergoing primary THA from January 1, 2009, to December 31, 2020, were included. The DMARD users were identified by at least one prescription within 90 to 360 days preoperatively. Propensity score matching (1:1) was done based on demographics, comorbidities, and corticosteroid use. The 90-day complication rates and 2-year implant survivorship were assessed. A total of 26,867 patients were identified, including 4,022 (15.0%) on DMARD therapy.
Results:
Survivorship from aseptic revision did not vary at two years between DMARD users and controls or among DMARD types. When stratified by type, biologic DMARD users exhibited a higher rate of periprosthetic joint infection compared to both conventional DMARD users (3.9 versus 2.1%, P = 0.003) and controls (3.9 versus 2.6%; P = 0.007), which was predominantly driven by periprosthetic joint infection rates for those on interleukin-6 inhibitors (7.9%) and anti-TNF medications (3.7%).
Conclusions:
Conventional DMARD therapy was not associated with worse 2-year outcomes, while biologic DMARD use was associated with reduced 2-year implant survivorship due to septic revision. These findings underscore the importance of coordinated perioperative management in accordance with the guidelines regarding DMARD use and highlight the need for collaboration between orthopaedic surgeons and rheumatologists. Further investigation is needed to determine whether the observed associations are driven by underlying immune dysregulation, specific DMARD effects, or unmeasured confounding.
Level Of Evidence:
III.
