The Rheumatoid hip

Rheumatoid Arthritis (RA) is among the most common systemic diseases of connective tissue, affecting 1,5% of the population. In recent years about 30 000 new cases of RA have been reported annually. The rheumatoid process has a progressive course, leading to system-wide destruction of bones and joints, along with damage to many other organs and systems. The treatment team involved in managing cases of RA must be composed of specialists from many different fields: orthopedic surgeons, rheumatologists, physiotherapists, social workers, occupational therapists, and visiting nurses.
The treatment goal is to improve the patient's quality of life, to reduce or eliminate pain, and in the most severe cases to facilitate nursing care. In the surgical treatment of these patients the procedures used include synovectomy, joint debridement, soft tissue relaxation operations, arthrodesis, osteotomy, resection arthroplasty, and joint replacement. Among the more than 100 known connective tissue diseases, the hip joint is most commonly involved in cases of rheumatoid arthritis and ankylosing spondylitis. In cases of substantial destruction of the hip, the treatment of choice is joint replacement. Both cemented and cementless prostheses are used in the treatment of RA patients, depending on the surgeon's experience and the patient's age, general clinical status, and the quality of the bone tissue. Postoperative treatment in these patients does not differ from the generally accepted standards for the treatment of degenerative diseases. Based on the author's own experience in the Rheumatoorthopedic Department at the Institute of Rheumatology, it can safely be stated that hip joint replacement is a valuable and well tested method in the treatment of destructive changes to the hip joints in RA patients.