Cemented primary total arthroplasty for acetabular protrusion in patients with rheumatoid arthritis

The degenerative changes in hip joints observed in patients RA are associated with acetabular bone deficiencies. Therefore total hip arthroplasty performed in such patients requires bone grafting to restore the deficiencies. The aim of the study was to assess the long term-term results of primary total hip arthroplasty in patients with RA including an assessment of the usefulness of auto-and allograft in restoring bone deficiencies in acetabular protrusion.

From 1991 to 2001 a total of 156?? [w tekście jest mowa o 158] patients with rheumatoid arthritis of the hip joint underwent a primary total arthroplasty of the hip joint with acetabular protrusion. The reconstruction of the acetabular bone was achieved by morsellized impaction auto-and allografting. Group I included 26 patients who received autografts and Group II consisted of 10 patients who received allografts. The mean follow-up was 5 years. The hip joint performance was assessed according to the following scales: WOMAC, HHS, and Merle-d'Aubigne-Postel. Graft incorporation was graded according to the Avci criteria.

The study revealed that auto-and allografting provides good long-term results. Graft incorporation was reported after 26 months. The radiographs showed porotic bone in grafts in one of the patients; however, there were no signs of loosening in the prosthetic acetabulum.

Restoration of bone deficiencies in the medial part of the acetabulum in patients with RA by bone grafting is a biological way of reconstruction of the bone and facilitates stable fixation of a polyethylene acetabulum.