TOTAL HIP-ARTHROPLASTY IN PATIENTS WITH JUVENILE CHRONIC RHEUMATOID-ARTHRITIS

Citation
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
Citations number
28
Categorie Soggetti
Orthopedics,Rheumatology
ISSN journal
09519580
Volume
9
Issue
4
Year of publication
1996
Pages
187 - 193
Database
ISI
SICI code
0951-9580(1996)9:4<187:THIPWJ>2.0.ZU;2-S
Abstract
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.