AAOS: Reduced Surgery Rates Document RA Treatment Success

Orthopedic surgeons are giving very public credit to rheumatology this week at their annual meeting. Although rates of both knee and cervical spine surgery have increased dramatically in the past few decade, the prevalences of total knee replacement (TKR) and cervical spine fusion among patients with rheumatoid arthritis (RA) have declined during the same period, according to two studies presented at the American Academy of Orthopaedic Surgeons meeting in Chicago. The authors of both studies credit dramatic improvements in drug treatments for RA.

Data in the Finnish Arthroplasty Register from 1980 through 2010 show a 20-fold increase in the overall incidence of TKRs, reported Eerik T. Skytta MD and coworkers from the COXA Hospital for Joint Replacement in Tampere, Finland. But the annual incidence of TKRs among RA patients has been gradually decreasing, most noticeably among patients over the age of 60 since 2005. (A separate analysis has shown a steady increase in patients with osteoarthritis over the three decades before 2011.)

To the authors' knowledge, this is the first time a decline in TKRs among RA patients has been demonstrated on a population level. It is due at least in part, they say to "early and aggressive approach to treatment and the availability of new effective treatments."

Researchers from Johns Hopkins Medicine report a similar trend in utilization of cervical spine fusions over a similar period, observed in data from the US National Inpatient Sample. Between 1992 and 2008, there was a 6.8% increase per year in cervical fusions among patients without RA, while those among patients with a diagnosis of RA declined by 1.6% per year. Johns Hopkins spine surgeon Khaled Kebaish MD and his coworkers credit the same developments: early, aggressive treatment and improved medical therapies.