Objective: The guidelines for the management of rheumatoid arthritis issued by the Japan College of Rheumatology 2014, equally recommend uncemented total hip arthroplasty (THA) for patients with rheumatoid arthritis (RA), compared to cemented THA. In our institution, all THAs have been performed with cement. In the current study, we aimed to evaluate the clinical benefits of cemented THA for patients with RA.
Methods: Eighty-two patients with RA (98 joints) were retrospectively reviewed after they had cemented THAs performed at our institution, from January 2006 to November 2014, inclusive. There were 12 males (14 joints) and 70 females (84 joints). The mean age was 64.3 (range, 34-83) years old, the mean height was 152.4 (range, 132.8-170.0) cm, the mean weight was 50.0 (range, 32.1-75.0) kg, and the mean disease duration from development of RA to index surgery was 13.3 (range, 0.5-46) years, respectively. All THAs were performed via the direct lateral approach in the lateral position using a complete polyethylene socket and polished tapered stem with antibiotic-loaded acryl cement (ALAC). Eighty-two joints out of 98 could be followed up after two years from the index surgery, and 41 joints of the 98 could be followed up after five years. We evaluated the survivorship of implants, the clinical outcomes, and the occurrence of adverse events including deep infection, dislocation, and aseptic loosening.
Results: Of 98 THAs, only one revision THA was performed for multiple dislocations within the first year after the index surgery. The mean Japanese Orthopaedic Association hip score improved from 39.3 points preoperatively to 83.4 points two years after the index surgery in 65 patients (82 joints), and to 86.3 points five years after the index surgery in 30 patients (41 joints).
Discussion: There were no revision THAs for deep infection or aseptic loosening, and only one revision THA was performed for multiple dislocations. It is considered that cemented THAs using ALAC by optimal surgical techniques (using modern cementing techniques including bone-bed preparation, use of bone plagues, retrograde injection with cement gun, pressurization, and vacuum mixing) has great benefits for patients with RA due to the longevity and the resistance to deep infection.
Conclusion: Use of cemented THAs in patients with RA is an effective option with good device survival, and minimal associated dislocations or infections.
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