Dh. Sochart et K. Hardinge, TOTAL HIP-ARTHROPLASTY IN PATIENTS WITH JUVENILE CHRONIC RHEUMATOID-ARTHRITIS, Journal of orthopaedic rheumatology, 9(4), 1996, pp. 187-193
Total hip arthroplasty is the most successful major elective surgical
procedure. The prosthesis can however be subject to wear and aseptic l
oosening with consequent loss of function. These, usually late, compli
cations have acted as a constraint to its widespread application in th
e younger patient particularly when the bone is friable or deformed as
in juvenile chronic rheumatoid arthritis (JCRA). Revision rates of 25
% have been reported when using conventional prostheses with loosening
rates of up to 43.5% at 5 years. These patients therefore represent t
he worst possible scenario for athroplasty and their importance is dis
proportionate to their numbers as they can give a clear indication of
the expected behaviour of an implant. If an arthroplasty performs well
; in this high risk group then it could also be expected to have favou
rable results when used in the common denominator group of mature pati
ents with degenerative arthrosis. We present the results of the use of
the Wrightington Frusto-Conical femoral prosthesis for total hip repl
acement performed on a group of patients with polyarticular juvenile c
hronic rheumatoid arthritis. Sixteen total hip arthroplasties were per
formed on 11 patients whose average age at the time of operation was 3
1 years (17-44). Average disease duration prior to surgery was 14.1 ye
ars (6-29) and length of follow up averaged 9.56 years (4.5-14.5). All
patients experienced significant relief of pain and functional improv
ement and no hip has yet required a revision procedure. There was no e
vidence of loosening of the femoral component but radiolucent zones de
veloped around five of the acetabular cups of which three were loose,
but remained asymptomatic.