The influence of technique on fixation of primary total hip arthroplasty in patients with rheumatoid arthritis.
This is a prospective, consecutive study of 98 total hip arthroplasties implanted by 1 surgeon in 66 patients with rheumatoid arthritis. The mean follow-up time was 7.4 years (range, 2-13 years). All 98 acetabular components were uncemented titanium fiber metal-coated components fixed with multiple screws. Sixty-five hips had bulk or cancellous allograft for protrusio acetabuli. Following a prospective protocol based on patient age, 51 hips had an uncemented femoral component, and 47 hips had a cemented femoral component. Using the Harris Hip Score, 30 hips were rated as excellent; 44, good; 15, fair; and 9, poor. There were no early deep infections. One hybrid hip was removed for late metastatic infection at 7 years. Radiographic evaluation of 98 acetabular components showed 1 case of septic loosening, 2 cases of aseptic loosening (1 patient asymptomatic), and 1 case with severe wear and ischial osteolysis. None of the 47 cemented femoral components subsided, and osteolysis was seen in only 3 femora (7%). Of the 51 uncemented femoral components, subsidence occurred in 7 hips (14%), and osteolysis occurred in 15 hips (30%). Uncemented acetabular components have a high rate of success in patients with rheumatoid arthritis who have a total hip arthroplasty. There is a high rate of subsidence and osteolysis, however, with first-generation cementless femoral components.
Thomason
H C
HC
Department of Orthopaedics, University of North Carolina, Chapel Hill, NC 27599, USA.
Lachiewicz
P F
PF
D000077:Acetabulum; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005269:Femur; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome