Hip replacement arthroplasty in rheumatoid arthritis

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Biomaterials

Background:

• Rheumatoid arthritis presents unique challenges for hip arthroplasty compared to osteoarthritis.
• Patients with rheumatoid arthritis are often younger, raising concerns about prosthesis longevity.
• Polyarticular involvement in rheumatoid arthritis can paradoxically protect hip arthroplasty by reducing weight-bearing stress.

Purpose of the Study:

• To highlight the distinct considerations for hip arthroplasty in rheumatoid arthritis patients.
• To advocate for bone grafting techniques in managing protrusio acetabuli during hip replacement for rheumatoid arthritis.
• To discuss the implications of polyarticular disease and potential contraindications for surgery.

Main Methods:

• Comparative analysis of hip arthroplasty in rheumatoid arthritis versus osteoarthritis.
• Description of protrusio acetabuli as a common presentation in rheumatoid arthritis.
• Recommendation for acetabular floor grafting using autologous bone (femoral head) for protrusio acetabuli.

Main Results:

• Protrusio acetabuli is more prevalent in rheumatoid arthritis due to specific cartilage degradation patterns.
• Acetabular grafting with bone provides stronger, more physiological support than synthetic alternatives.
• Multiple joint arthroplasties in rheumatoid arthritis patients often yield gratifying functional outcomes.

Conclusions:

• Hip arthroplasty in rheumatoid arthritis requires tailored approaches, particularly for protrusio acetabuli.
• Autologous bone grafting is a preferred method for acetabular reconstruction in protrusio acetabuli.
• Careful patient selection and perioperative antibiotic prophylaxis are crucial, considering risks like late infection.