Rates of long-term risk of revision and complications in total elbow arthroplasty in patients with rheumatoid arthritis: a propensity score-matched analysis

Background

Rheumatoid arthritis (RA) poses unique challenges in total elbow arthroplasty (TEA) due to systemic inflammation. Previous studies suggest higher revision rates in RA patients after TEA, yet comprehensive investigations have not been conducted. We theorized that RA patients undergoing TEA would demonstrate a greater likelihood and risk of requiring revision procedures compared to those without RA. We aimed to assess revision incidence and complications in an RA compared to a non-RA cohort.

Methods

A retrospective cohort study was conducted using data from the PearlDiver database to analyze patients who underwent TEA between from January 2010 and October 2022. The study population was divided into RA and non-RA cohorts. The primary outcome was 5-year all-cause revision incidence. Secondary outcomes were elbow fracture, infection, instability, and triceps and nerve injury. Potential contributing factors such as immunosuppressive drug use and perioperative flares were assessed. Demographic characteristics including age, sex, and Charlson Comorbidity Index were noted for each cohort. Propensity score-matching aligned RA TEA patients with a general TEA (non-RA) population. Matching used a 1:4 ratio, after cumulative incidence was assessed via Kaplan–Meier analysis.

Results

Following matching, 499 RA patients were compared with 1949 general matched control (non-RA) patients. The RA group had a higher 5-year cumulative incidence of revision after TEA compared to the non-RA cohort (4.3% vs. 1.4%, hazard ratio: 2.95, 95% confidence interval: 1.63-5.34, P< .001). However, there were no significant differences in complication rates between the 2 groups within 5 years after the initial procedure. No significant difference in elbow instability after TEA was observed between the RA and non-RA cohorts.

Conclusions

Our study provides evidence supporting the notion that RA patients undergoing TEA are at a higher risk of revision procedures. Despite comparable complication rates between RA and non-RA cohorts, further investigation into the underlying mechanisms of increased revision rates in RA patients is warranted.