{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:38:36Z","timestamp":1792694316310,"version":"4.5.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Whether coded rheumatoid arthritis (RA) among patients undergoing elective total hip arthroplasty (THA) is associated with excess short-term inpatient morbidity in contemporary U.S. practice remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study using the National Inpatient Sample (2016\u20132021). Adults undergoing elective primary THA were identified using ICD-10-CM\/PCS codes. The exposure cohort included admissions with coded RA in any diagnosis position. The comparator cohort included admissions with narrow primary hip osteoarthritis (OA) as the principal diagnosis and no RA. Propensity scores were estimated from demographic, socioeconomic, hospital, and comorbidity variables. Inverse probability of treatment weighting (IPTW) with survey weighting was used for the primary analysis, followed by doubly adjusted regression models that included age and all variables with persistent post-weighting imbalance greater than 0.10 (female sex, osteoporosis, chronic obstructive pulmonary disease, chronic anemia, depression, and race). Additional sensitivity analyses included stricter weight truncation, a restriction analysis, conventional multivariable modeling, and sex-stratified analyses addressing residual sex imbalance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 274,582 admissions met eligibility criteria; 274,539 were included in the final analytic cohort after exclusion of 43 records with missing or invalid propensity-weight inputs. The analytic cohort included 7,264 RA admissions and 267,275 OA admissions. In the primary weighted analysis, RA was associated with higher odds of acute blood loss anemia (OR 1.30, 95% CI 1.23\u20131.38), red blood cell transfusion (OR 1.40, 95% CI 1.23\u20131.60), acute kidney injury (OR 1.47, 95% CI 1.26\u20131.71), non-home discharge (OR 1.27, 95% CI 1.19\u20131.36), and a composite hematologic\/renal in-hospital complication (OR 1.31, 95% CI 1.24\u20131.39).RA was also associated with slightly longer length of stay (+\u20090.14 days, 95% CI\u2009+\u20090.10 to +\u20090.19) and modestly higher total hospital charges (+$1,018, 95% CI +$89 to +$1,947). Findings were directionally consistent across sensitivity analyses, including stricter weight truncation, restriction to admissions with principal OA plus concomitant RA, and sex-stratified analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this contemporary national THA cohort, coded RA was associated with a small but consistent increase in in-hospital complication and resource-utilization burden compared with OA. These findings should be interpreted as adjusted associations rather than causal effects, and the modest effect sizes should not be overstated. They may provide context for perioperative risk assessment and discharge planning among patients with coded RA undergoing elective THA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06523-w","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:09:09Z","timestamp":1791385749000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Elective primary total hip arthroplasty in rheumatoid arthritis versus osteoarthritis: in-hospital outcomes from the national inpatient sample, 2016\u20132021"],"prefix":"10.1007","volume":"146","author":[{"given":"Binyamin","family":"Finkel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4749-7691","authenticated-orcid":false,"given":"Hadar","family":"Gan-Or","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9998-0818","authenticated-orcid":false,"given":"Shaked","family":"Ankol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamd","family":"Tawatha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Behrbalk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"1","key":"6523_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1136\/ard-2022-223356","volume":"82","author":"JS Smolen","year":"2023","unstructured":"Smolen JS, Landew\u00e9 RBM, Bergstra SA et al (2023) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis 82(1):3\u201318. https:\/\/doi.org\/10.1136\/ard-2022-223356","journal-title":"Ann Rheum Dis"},{"issue":"7","key":"6523_CR2","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1002\/acr.24596","volume":"73","author":"L Fraenkel","year":"2021","unstructured":"Fraenkel L, Bathon JM, England BR et al (2021) 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 73(7):924\u2013939. https:\/\/doi.org\/10.1002\/acr.24596","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"5","key":"6523_CR3","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1093\/rheumatology\/keab643","volume":"61","author":"VY Zhou","year":"2022","unstructured":"Zhou VY, Lacaille D, Lu N et al (2022) Has the incidence of total joint arthroplasty in rheumatoid arthritis decreased in the era of biologics use? A population-based cohort study. Rheumatology (Oxford) 61(5):1819\u20131830. https:\/\/doi.org\/10.1093\/rheumatology\/keab643","journal-title":"Rheumatology (Oxford)"},{"issue":"5","key":"6523_CR4","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1136\/annrheumdis-2017-212424","volume":"77","author":"RL Cordtz","year":"2018","unstructured":"Cordtz RL, Hawley S, Prieto-Alhambra D et al (2018) Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers. Ann Rheum Dis 77(5):684\u2013689. https:\/\/doi.org\/10.1136\/annrheumdis-2017-212424","journal-title":"Ann Rheum Dis"},{"issue":"9","key":"6523_CR5","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.1002\/acr.24893","volume":"74","author":"SM Goodman","year":"2022","unstructured":"Goodman SM, Springer BD, Chen AF et al (2022) 2022 American College of Rheumatology\/American Association of Hip and Knee Surgeons Guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Care Res (Hoboken) 74(9):1399\u20131408. https:\/\/doi.org\/10.1002\/acr.24893","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"8","key":"6523_CR6","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1002\/acr.23274","volume":"69","author":"SM Goodman","year":"2017","unstructured":"Goodman SM, Springer B, Guyatt G et al (2017) 2017 American College of Rheumatology\/American Association of Hip and Knee Surgeons Guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee Arthroplasty. Arthritis Care Res (Hoboken) 69(8):1111\u20131124. https:\/\/doi.org\/10.1002\/acr.23274","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"4","key":"6523_CR7","doi-asserted-by":"publisher","first-page":"R145","DOI":"10.1186\/ar3087","volume":"12","author":"M Gilson","year":"2010","unstructured":"Gilson M, Gossec L, Mariette X et al (2010) Risk factors for total joint arthroplasty infection in patients receiving tumor necrosis factor \u03b1-blockers: a case-control study. Arthritis Res Ther 12(4):R145. https:\/\/doi.org\/10.1186\/ar3087","journal-title":"Arthritis Res Ther"},{"issue":"6","key":"6523_CR8","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1136\/ard-2022-223335","volume":"82","author":"GE Fragoulis","year":"2023","unstructured":"Fragoulis GE, Nikiphorou E, Dey M et al (2023) 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 82(6):742\u2013753. https:\/\/doi.org\/10.1136\/ard-2022-223335","journal-title":"Ann Rheum Dis"},{"issue":"2","key":"6523_CR9","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s40744-021-00414-9","volume":"9","author":"O Taylor-Williams","year":"2022","unstructured":"Taylor-Williams O, Bushell A, Nossent J et al (2022) Total hip replacement in patients with rheumatoid arthritis: trends in incidence and complication rates over 35 years. Rheumatol Ther 9(2):565\u2013580. https:\/\/doi.org\/10.1007\/s40744-021-00414-9","journal-title":"Rheumatol Ther"},{"issue":"12","key":"6523_CR10","doi-asserted-by":"publisher","first-page":"3839","DOI":"10.1002\/art.37690","volume":"64","author":"B Ravi","year":"2012","unstructured":"Ravi B, Escott B, Shah PS et al (2012) A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum 64(12):3839\u20133849. https:\/\/doi.org\/10.1002\/art.37690","journal-title":"Arthritis Rheum"},{"issue":"2","key":"6523_CR11","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1002\/art.38231","volume":"66","author":"B Ravi","year":"2014","unstructured":"Ravi B, Croxford R, Hollands S et al (2014) Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis. Arthritis Rheumatol 66(2):254\u2013263. https:\/\/doi.org\/10.1002\/art.38231","journal-title":"Arthritis Rheumatol"},{"issue":"3","key":"6523_CR12","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1002\/art.38205","volume":"66","author":"B Ravi","year":"2014","unstructured":"Ravi B, Croxford R, Austin PC et al (2014) Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty. Arthritis Rheumatol 66(3):488\u2013496. https:\/\/doi.org\/10.1002\/art.38205","journal-title":"Arthritis Rheumatol"},{"key":"6523_CR13","doi-asserted-by":"publisher","first-page":"152061","DOI":"10.1016\/j.semarthrit.2022.152061","volume":"56","author":"Y Zhang","year":"2022","unstructured":"Zhang Y, Chu SS, Liu K et al (2022) Outcomes in patients with rheumatoid versus osteoarthritis for total hip arthroplasty: a meta-analysis and systematic review. Semin Arthritis Rheum 56:152061. https:\/\/doi.org\/10.1016\/j.semarthrit.2022.152061","journal-title":"Semin Arthritis Rheum"},{"issue":"5","key":"6523_CR14","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1007\/s00264-023-05728-7","volume":"47","author":"W Jiang","year":"2023","unstructured":"Jiang W, Xu H, Wang X et al (2023) More complications and higher transfusion rate in patients with rheumatoid arthritis than osteoarthritis undergoing total hip arthroplasty. Int Orthop 47(5):1189\u20131196. https:\/\/doi.org\/10.1007\/s00264-023-05728-7","journal-title":"Int Orthop"},{"issue":"9","key":"6523_CR15","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.3899\/jrheum.140011","volume":"41","author":"SM Goodman","year":"2014","unstructured":"Goodman SM, Ramsden-Stein DN, Huang WT et al (2014) Patients with rheumatoid arthritis are more likely to have pain and poor function after total hip replacements than patients with osteoarthritis. J Rheumatol 41(9):1774\u20131780. https:\/\/doi.org\/10.3899\/jrheum.140011","journal-title":"J Rheumatol"},{"issue":"1","key":"6523_CR16","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.semarthrit.2019.06.007","volume":"50","author":"R Cordtz","year":"2020","unstructured":"Cordtz R, Odgaard A, Kristensen LE et al (2020) Risk of medical complications following total hip or knee arthroplasty in patients with rheumatoid arthritis: a register-based cohort study from Denmark. Semin Arthritis Rheum 50(1):30\u201335. https:\/\/doi.org\/10.1016\/j.semarthrit.2019.06.007","journal-title":"Semin Arthritis Rheum"},{"issue":"2","key":"6523_CR17","doi-asserted-by":"publisher","first-page":"205","DOI":"10.3899\/jrheum.201370","volume":"49","author":"A Yazdanyar","year":"2022","unstructured":"Yazdanyar A, Donato A, Wasko MC, Ward MM (2022) Risk of 30-day readmission after knee or hip replacement in rheumatoid arthritis and osteoarthritis by non-medicare and medicare payer status. J Rheumatol 49(2):205\u2013212. https:\/\/doi.org\/10.3899\/jrheum.201370","journal-title":"J Rheumatol"},{"issue":"12","key":"6523_CR18","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1002\/art.24060","volume":"59","author":"T Bongartz","year":"2008","unstructured":"Bongartz T, Halligan CS, Osmon DR et al (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 59(12):1713\u20131720. https:\/\/doi.org\/10.1002\/art.24060","journal-title":"Arthritis Rheum"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06523-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-026-06523-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06523-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:47:32Z","timestamp":1792691252000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-026-06523-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6523"],"URL":"https:\/\/doi.org\/10.1007\/s00402-026-06523-w","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"9 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2026","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Equal contribution statement was missing from this article and has now been updated.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study used de-identified data from the National Inpatient Sample (NIS). The institutional ethics committee determined that formal Helsinki Committee approval was not required because the data are fully de-identified and cannot be linked to identifiable individual patients. Informed consent was therefore not applicable.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"363"}}