Ten-year hip and knee arthroplasty implant survival in patients with inflammatory arthritis receiving methotrexate monotherapy compared with osteoarthritis: a registry-based data linkage study

The aim of this study was to evaluate the 10-year risk of revision surgery following total hip (THA) and knee (TKA) arthroplasty in patients with inflammatory arthritis (IA) receiving perioperative methotrexate (MTX) monotherapy and to compare their outcomes with those of propensity score–matched patients undergoing arthroplasty for osteoarthritis. We conducted a retrospective study using data from the Emilia-Romagna Orthopedic Arthroplasty Implants Register. The primary cohort included patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis residing in Emilia-Romagna (Italy) who underwent primary THA or TKA and received at least one prescription of MTX within 90 days before or after surgery. The control cohort consisted of propensity score-matched patients who underwent THA/TKA for osteoarthritis. The perioperative MTX-treated IA group included 225 patients who underwent THA and 215 patients who underwent TKA. The control group consisted of 449 patients with osteoarthritis who received THA and 428 patients who received TKA. Implant survival rates at 10 years were not significantly different when comparing IA patients perioperatively treated with MTX monotherapy and matched osteoarthritis patients, in either those who underwent THA or TKA. This remained consistent when accounting for competing risk of death. These findings suggest that patients with IA receiving perioperative MTX monotherapy have 10-year revision outcomes comparable to those of propensity score–matched patients with osteoarthritis.