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Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers
  1. Rene Lindholm Cordtz1,2,
  2. Kristian Zobbe1,2,
  3. Pil Højgaard1,2,
  4. Lars Erik Kristensen2,
  5. Søren Overgaard3,4,
  6. Anders Odgaard5,6,
  7. Hanne Lindegaard4,7,
  8. Lene Dreyer1,2,6
  1. 1 Department of Rheumatology, Gentofte Hospital, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
  2. 2 Bispebjerg and Frederiksberg Hospital, The Parker Institute, Frederiksberg, Denmark
  3. 3 Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
  4. 4 Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  5. 5 Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
  6. 6 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  7. 7 Department of Rheumatology, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr Rene Lindholm Cordtz, Center for Rheumatology and Spine Diseases, Rigshospitalet - Gentofte, Kildegaardsvej 28, 2900-Hellerup, Denmark; rene.lindholm.cordtz.03{at}


Objectives To investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.

Methods Register-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.

Results In total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality.

Conclusion Patients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.

  • rheumatoid arthritis
  • orthopaedic surgery
  • DMARDs (biologic)
  • infections
  • epidemiology

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  • Handling editor Josef S Smolen

  • Contributors RLC and LD had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: RLC, LD, AO, LEK and SO. Acquisition, analysis and interpretation of data: all authors. Drafting of the manuscript: RLC. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: RLC and LD. Study supervision: LD, AO, LEK and SO.

  • Funding The study was funded by The Danish Rheumatism Association, The Bjarne Jensen Foundation, the Oak Foundation and the Danish Council for Independent Research.

  • Competing interests PH has received speaking fees from Celgene and UCB outside the present work. LEK has received fees for speaking and/or consultancy from Pfizer, AbbVie, Amgen, UCB, Celgene, BMS, Biogen, Sanofi, MSD, Novartis, Eli Lilly and Janssen Pharmaceuticals. LD has received speaking fees from MSD and UCB outside the present work.

  • Ethics approval According to Danish legislation, publication of data from registers and databases does not require patient consent or ethics approval. Approval was given by the Danish Data Protection Agency (GEH-2014-043, I-Suite: 03166).

  • Provenance and peer review Not commissioned; externally peer reviewed.