Total hip arthroplasty in rheumatoid arthritis
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Published:
Jun 30, 2014
Keywords:
Rheumatoid arthritis. Total hip arthroplasty. Loosening. Uncemented cups.
Main Article Content
Abstract
Background: Fifteen per cent of the patient with osteoarthritis secondary to rheumatoid arthritis will need total hip arthroplasty. The objective is to communicate our experience in total hip arthroplasty in patients with rheumatoid arthritis through a retrospective analysis, emphasizing the alternative prostheses and complications.
Methods: Forty eight primary total hip arthroplasties in 40 patients (mean age 58 years), with average 6-year follow-up were analyzed. Twenty three cemented, 21 hybrids and 4 uncemented total hip arthroplasties were performed. Clinical examination with Harris Hip Score, and radiographic studies at 21 and 45 days, 3, 6, and 12 months, and then annually were used for follow-up. We evaluate areas of DeLee-Charnley and Gruen to determine the prosthetic loosening.
Results: Average Harris Hip Score was 29.8 before surgery and 82.2 after it. Prosthetic survival reached 98% at 5 years. Eight years after surgery, three additional cases of prosthetic loosening were detected, and prosthetic survival was 87.5% in the medium term. All patients who needed surgical review had cemented implants. There were no signs of radiographic or clinical loosening in the hybrid and non-cemented prostheses.
Conclusions: Total hip arthroplasty constitutes a valid procedure that improves the quality of life of patients with rheumatoid arthritis with severe hip compromise. Results depend on several factors, such as type of prosthesis, clinical conditions and surgical technique. As it is published in the international literature, the use of uncemented cups improves prosthetic long-term survival.
Methods: Forty eight primary total hip arthroplasties in 40 patients (mean age 58 years), with average 6-year follow-up were analyzed. Twenty three cemented, 21 hybrids and 4 uncemented total hip arthroplasties were performed. Clinical examination with Harris Hip Score, and radiographic studies at 21 and 45 days, 3, 6, and 12 months, and then annually were used for follow-up. We evaluate areas of DeLee-Charnley and Gruen to determine the prosthetic loosening.
Results: Average Harris Hip Score was 29.8 before surgery and 82.2 after it. Prosthetic survival reached 98% at 5 years. Eight years after surgery, three additional cases of prosthetic loosening were detected, and prosthetic survival was 87.5% in the medium term. All patients who needed surgical review had cemented implants. There were no signs of radiographic or clinical loosening in the hybrid and non-cemented prostheses.
Conclusions: Total hip arthroplasty constitutes a valid procedure that improves the quality of life of patients with rheumatoid arthritis with severe hip compromise. Results depend on several factors, such as type of prosthesis, clinical conditions and surgical technique. As it is published in the international literature, the use of uncemented cups improves prosthetic long-term survival.
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How to Cite
Lopreite, F., Simesen de Bielke, H., Garabano, G., Gómez Rodríguez, G., Oviedo, A., & del Sel, H. (2014). Total hip arthroplasty in rheumatoid arthritis. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 79(2), 74-81. https://doi.org/10.15417/166
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Clinical Research
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10. Colville J, Raunio P. Charnley low-friction arthroplasties of the hip in rheumatoid arthritis. A study of the complications and
results of 378 arthroplasties. J Bone Joint Surg Br 1978;60:498-503.
11. Lachiewicz P. Porous-coated total hip arthroplasty in rheumatoid arthritis. J Arthroplasty 1994;9:9-15.
12. Poss R, Maloney J, Ewald F, Thomas W, Batte N, Hartness C, et al. Six to eleven-year results of total hip arthroplasty in
rheumatoid arthritis. Clin Orthop Relat Res 1984;182:109-16.
13. Ranawat C, Dorr L, Inglis A. Total hip arthroplasty in protrusion acetabuli of rheumatoid arthritis. J Bone Joint Surg Am
1980;62:1059-65.
14. Sarmiento A, Ebramzadeh E, Gogan W, McKellop H. Total hip arthroplasty with cement. J Bone Joint Surg Am 1990;72:1470-
6.
15. Stauffer R. Ten-year follow-up study of total hip replacement. J Bone Joint Surg Am 1982;64:983-90.
16. Bogoch E, Moran E. Bone abnormalities in the surgical treatment of patients with rheumatoid arthritis. Clin Orthop Relat Res
1999;366:8-21.
17. Bogoch F, Gschwend N, Bogoch B, Rahn B, Perren S. Juxtaarticular bone loss in experimental inflammatory arthritis. J Orthop
Res 1988;6:648-65.
18. Unger A, Inglis A, Ranawat C, Johanson N. Total hip arthroplasty in rheumatoid arthritis: a long-term follow-up study.
J Arthroplasty 1987;2:191-7.
19. Severt R, Wood R, Cracchiolo A, Amstutz H. Long term follow-up of cemented total hip arthroplasty in rheumatoid arthritis.
Clin Orthop Rel Res 1991;265:137-45.
Año 79 • Número 2 • 2014 Artroplastia total de cadera en pacientes con artritis reumatoide 81
20. Learmonth I, Dall D, Solomon M, Heywood A. A comparison of the results of Charnley low friction arthroplasty in rheumatoid
arthritis and osteoarthritis. Clin Orthop Relat Res 1991;4:47-61.
21. Lachiewicz P, McCaskill B, Inglis A, Ranawat C, Rosenstein B. Total hip arthroplasty in juvenile rheumatoid arthritis: two to
eleven-year results. J Bone Joint Surg Am 1986;68:502-8.
22. Cracchiolo A, Severt R, Moreland J. Uncemented total hip arthroplasty in rheumatoid arthritis diseases. Clin Orthop Relat Res
1992;277:166-74.
23. Erwin W, Morscher M. Current status of acetabular fixation in primary total hip arthroplasty. Clin Orthop Relat Res
1992;274:172-93.
24. Lopreite F, Pesciallo C, Benitez E, del Sel H. Infección en artroplastia total de cadera y rodilla. Congreso Argentino de Ortopedia
y Traumatología, diciembre de 2008.
25. Wymenga A, Van Horn J, Theeuwes A, Muytjens H, Slooff T. Perioperative factors associated with septic arthritis after
arthroplasty: prospective multicenter study of 362 knees and 2651 hip operations. Acta Orthop Scand 1992;63:665-71.
26. Eskelinen A, Paavolainen P, Helenius I, Pulkkinen P, Remes V. Total hip arthroplasty for rheumatoid arthritis in younger
patients: 2557 replacements in the Finnish Arthroplasty Register followed for 0-24 years. Acta Orthopaedica 2006;77(6):853-65.
Medicina Interna, Madrid: Harcourt; 2000:1158-66.
2. Panayi G. The pathogenesis of rheumatoid arthritis: from molecules to the whole patient. Br J Rheumatol 1993;32:533-6.
3. Roig Escofet D. Artritis reumatoidea. En: Farreras-Rozman. Medicina Interna, Barcelona: Doyma; 1996:1005-12.
4. Matsuno H, Yasuda T, Yudoh K. Cementless cup supporter for protrusio acetabuli in patients with rheumatoid arthritis. Internat
Orthopaedics (SICOT) 2000;24:15-8.
5. Thomason HC, Lachiewicz PF. The influence of technique on fixation of primary total hip arthroplasty in patients with
rheumatoid arthritis. J Arthroplasty 2001;16:628-34.
6. Bilsel N, Gokce A, Kesmezacar H, Mumcuoglu E, Ozdogan H. Long-term results of total hip arthroplasty in patients with
juvenile rheumatoid arthritis. Acta Orthop Traumatol Turc 2008;42(2):119-24.
7. Katsimihas M, Taylor A, Lee M, Sarangi P, Learmonth I. Cementless acetabular replacement in patients with rheumatoid
arthritis: 6 to 14-year prospective study. J Arthroplasty 2003;18:25-32.
8. DeLee J, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976;121:20-32.
9. Brooker A, Bowerman J, Robinson R, Riley L Jr. Ectopic ossification following total hip replacement: incidence and a method
of classification. J Bone Joint Surg Am 1973;55:1629-32.
10. Colville J, Raunio P. Charnley low-friction arthroplasties of the hip in rheumatoid arthritis. A study of the complications and
results of 378 arthroplasties. J Bone Joint Surg Br 1978;60:498-503.
11. Lachiewicz P. Porous-coated total hip arthroplasty in rheumatoid arthritis. J Arthroplasty 1994;9:9-15.
12. Poss R, Maloney J, Ewald F, Thomas W, Batte N, Hartness C, et al. Six to eleven-year results of total hip arthroplasty in
rheumatoid arthritis. Clin Orthop Relat Res 1984;182:109-16.
13. Ranawat C, Dorr L, Inglis A. Total hip arthroplasty in protrusion acetabuli of rheumatoid arthritis. J Bone Joint Surg Am
1980;62:1059-65.
14. Sarmiento A, Ebramzadeh E, Gogan W, McKellop H. Total hip arthroplasty with cement. J Bone Joint Surg Am 1990;72:1470-
6.
15. Stauffer R. Ten-year follow-up study of total hip replacement. J Bone Joint Surg Am 1982;64:983-90.
16. Bogoch E, Moran E. Bone abnormalities in the surgical treatment of patients with rheumatoid arthritis. Clin Orthop Relat Res
1999;366:8-21.
17. Bogoch F, Gschwend N, Bogoch B, Rahn B, Perren S. Juxtaarticular bone loss in experimental inflammatory arthritis. J Orthop
Res 1988;6:648-65.
18. Unger A, Inglis A, Ranawat C, Johanson N. Total hip arthroplasty in rheumatoid arthritis: a long-term follow-up study.
J Arthroplasty 1987;2:191-7.
19. Severt R, Wood R, Cracchiolo A, Amstutz H. Long term follow-up of cemented total hip arthroplasty in rheumatoid arthritis.
Clin Orthop Rel Res 1991;265:137-45.
Año 79 • Número 2 • 2014 Artroplastia total de cadera en pacientes con artritis reumatoide 81
20. Learmonth I, Dall D, Solomon M, Heywood A. A comparison of the results of Charnley low friction arthroplasty in rheumatoid
arthritis and osteoarthritis. Clin Orthop Relat Res 1991;4:47-61.
21. Lachiewicz P, McCaskill B, Inglis A, Ranawat C, Rosenstein B. Total hip arthroplasty in juvenile rheumatoid arthritis: two to
eleven-year results. J Bone Joint Surg Am 1986;68:502-8.
22. Cracchiolo A, Severt R, Moreland J. Uncemented total hip arthroplasty in rheumatoid arthritis diseases. Clin Orthop Relat Res
1992;277:166-74.
23. Erwin W, Morscher M. Current status of acetabular fixation in primary total hip arthroplasty. Clin Orthop Relat Res
1992;274:172-93.
24. Lopreite F, Pesciallo C, Benitez E, del Sel H. Infección en artroplastia total de cadera y rodilla. Congreso Argentino de Ortopedia
y Traumatología, diciembre de 2008.
25. Wymenga A, Van Horn J, Theeuwes A, Muytjens H, Slooff T. Perioperative factors associated with septic arthritis after
arthroplasty: prospective multicenter study of 362 knees and 2651 hip operations. Acta Orthop Scand 1992;63:665-71.
26. Eskelinen A, Paavolainen P, Helenius I, Pulkkinen P, Remes V. Total hip arthroplasty for rheumatoid arthritis in younger
patients: 2557 replacements in the Finnish Arthroplasty Register followed for 0-24 years. Acta Orthopaedica 2006;77(6):853-65.