Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty

Background and Objectives — Total joint arthroplasty (TJA) presents unique surgical challenges in persons with rheumatoid arthritis (RA). The authors determined the relationship between surgeon experience with, and complications following, TJA in persons with RA.

Methods — Using administrative data, a cohort of RA patients with at least one primary elective hip or knee replacement between 2002 and 2009 was assembled. Cox proportional hazards, censored on death, and accounting for clustering of patients within surgeons, were used to determine the relationship between overall and 'RA-specific' surgeon TJA volume and the occurrence of a composite 'complication' outcome (revision, infection, dislocation or peri-prosthetic fracture within 2 years of the initial TJA), controlling for potential confounders (patient age, sex, co-morbidity, and disease severity).

Results — The authors identified 4,762 eligible TJAs (1,515 THAs and 3,247 TKAs) in persons with RA. Of these, 152 (3.3%) experienced a surgical complication within 2 years of their procedure. Controlling for patient and hospital factors, greater surgeon TJA volume in persons with RA, but not overall TJA volume, was associated with a reduced risk for complications (adjusted HR per additional 10 cases: RA volume 0.81, 95%CI 0.71-0.93, p=0.002; overall volume: 0.98, 95%CI 0.97-1.00, p=0.09).

Conclusions — In a cohort of hip and knee TJA recipients with RA, the authors found that increased surgeon experience performing TJA in patients with RA, irrespective of their overall TJA experience and hospital factors, was associated with a decreased risk of surgical complications. These findings have potential implications for surgeon training and the referral practices of rheumatologists.