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Observational Study
. 2024 Apr 2;63(4):970-976.
doi: 10.1093/rheumatology/kead304.

The influence of biological DMARDs on aseptic arthroplasty loosening: a retrospective cohort study

Markus M Schreiner  1 , Jennifer Straub  1 , Sebastian Apprich  1 , Kevin Staats  1 , Reinhard Windhager  1 , Daniel Aletaha  2 , Christoph Böhler  1
Affiliations
Observational Study

The influence of biological DMARDs on aseptic arthroplasty loosening: a retrospective cohort study

Markus M Schreiner et al. Rheumatology (Oxford). .

Abstract

Objective: To investigate whether biological DMARDs affect the risk of aseptic loosening after total hip/knee arthroplasty (THA/TKA) in patients with RA.

Methods: We retrospectively identified all patients suffering from RA who underwent THA/TKA at our academic centre between 2002 and 2015 and linked them with an existing prospective observational RA database at our institution. The risk of aseptic loosening was estimated using radiological signs of component loosening (RCL). A time-dependent Cox regression analysis was used to compare the risk of implant loosening between patients treated with traditional DMARDS and biological DMARDs, or alternately both over time.

Results: A total of 155 consecutive total joint arthroplasties (TJAs) (103 TKA vs 52 THA) was retrospectively included in the study. Mean age at implantation was 59 ± 13 years. Mean follow-up time was 69 ± 43 months. Overall, 48 (31%) TJAs showed signs of RCL, with 28 (27.2%) RCLs occurring after TKA compared with 20 after THA (38.5%). A significant difference regarding the incidence of RCL between the traditional DMARDs group (39 cases of RCL, 35%) and the biological DMARDs group (nine cases of RCL, 21%) (P = 0.026) was observed using the log-rank test. This was also true when using a time-dependent Cox regression with therapy as well as arthroplasty location (hip vs knee) as variables (P = 0.0447).

Conclusion: Biological DMARDs may reduce the incidence of aseptic loosening after TJA in patients with RA compared with traditional DMARDs. This effect seems to be more pronounced after TKA than THA.

Keywords: RA; aseptic loosening; biological DMARDs; total hip arthroplasty; total knee arthroplasty.

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Figures

Figure 1.
Figure 1.
Scatter plot depicting the time-integrated level of disease activity using the area under the Simplified Disease Activity Index curve (SDAIAUC) according to the date of implantation of the total joint replacement of the subset of patients with continuous documentation of their SDAI scores (n = 29)
Figure 2.
Figure 2.
Boxplot comparing the time-integrated level of disease activity using the area under the Simplified Disease Activity Index curve (SDAIAUC) in the subset of patients with continuous documentation of their SDAI scores (n = 29) between patients who were treated predominantly with biological DMARDs (n = 14) (10.94 ± 10.20 SDAIAUC) vs. patients who were treated predominantly with conventional DMARDs (n = 15) (11.90 ± 8.78 SDAIAUC)
Figure 3.
Figure 3.
Survival (follow-up time until lost-to-follow-up or RCL) in months for patients treated with traditional DMARDs vs. patients treated with biological DMARDs. For this analysis, patients who switched treatment regimens during follow-up (n = 20) were allocated to the treatment they received longer. Survival differed significantly (log-rank test P = 0.026)
Figure 4.
Figure 4.
Survival (follow-up time until lost-to-follow-up or RCL) in months for patients treated with traditional DMARDs vs. patients treated with biological DMARDs. For this analysis, all patients who received a biological DMARD at least once during follow-up were allocated to the biological DMARDs group. Survival differed significantly (log-rank test P = 0.012)
Figure 5.
Figure 5.
Survival (follow-up time until lost-to-follow-up or RCL) in months for patients treated with traditional DMARDs vs. patients treated with biological DMARDs. For this analysis, all patients who received a treatment with traditional DMARD only at least once during follow-up were allocated to the traditional DMARDs group. Survival did not differ significantly (P = 0.704)
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