This systematic review analysed published literature on total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) to estimate the incidence of THA and postoperative outcomes (revision, periprosthetic fracture, infection, aseptic loosening, dislocation, venous thromboembolism (VTE), and mortality) in patients with RA throughout the past four decades.

Medical management has resulted in a decreasing incidence of THA in patients with RA, while surgical and medical management has improved postoperative outcomes for patients with RA.

Not every postoperative outcome has improved: revision and periprosthetic fracture rates have decreased, infection and aseptic loosening have remained constant, and dislocation has increased.

Specific changes to RA management which have reduced THA incidence are likely to include acceptance of methotrexate (MTX) as first-line therapy, earlier initiation of synthetic disease-modifying antirheumatic drugs (sDMARD) therapy, and the introduction of biological disease-modifying antirheumatic drugs (bDMARDs).

Factors involved in changing complication rates include changing demographics, use of sDMARD and bDMARD therapy, newer surgical approaches, and improved thrombophylaxis.