title: Orthopedic surgery among patients with rheumatoid arthritis 1980-2007: a population-based study focused on surgery rates, sex, and mortality.
abstract: OBJECTIVE
  To describe current trends in arthritis-related joint surgery among a population-based cohort of patients with rheumatoid arthritis (RA) and to examine the influence of joint surgery on mortality.
  
  
  METHODS
  A retrospective medical record review was performed of all orthopedic surgeries following diagnosis in cases of adult-onset RA in Olmsted County, Minnesota, USA, in 1980-2007. Surgeries included primary total joint arthroplasty, joint reconstructive procedures (JRP), soft tissue procedures (STP), and revision arthroplasty. Cumulative incidence of surgery was estimated using Kaplan-Meier methods. Time trends, sex differences, and mortality were examined using Cox models with time-dependent covariates for surgery.
  
  
  RESULTS
  A total of 189 of 813 patients underwent at least 1 surgical procedure involving joints during followup. The cumulative incidence of any joint surgery at 10 years after RA incidence for the 1980-94 cohort was 27.3% compared to 19.5% for the 1995-2007 cohort (p = 0.08). The greatest reduction was in STP, which decreased from 12.1% in 1980-94 to 6.0% in 1995-2007 at 10 years after RA incidence (p = 0.012). Women had more surgery (cumulative incidence 26.6% at 10 years for women; 20.4% for men; p = 0.049), as did obese patients. JRP were significantly associated with mortality (hazard ratio 2.6; 95% CI 1.8, 3.9; p < 0.001) compared to patients not requiring JRP.
  
  
  CONCLUSIONS
  The rates of joint surgery continue to decrease for patients more recently diagnosed with RA. JRP is associated with increased mortality. These findings may reflect improved treatments for RA as well as continued higher disease burden among some patients.
authors.affiliation: Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Shourt
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.forename: Sherine E
authors.initials: SE
authors.lastname: Gabriel
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009985:Orthopedics / Q000706:statistics & numerical data* / Q000639:trends*; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate