Severt R, Wood R, Cracchiolo A, Amstutz H C
Division of Orthopaedic Surgery University of California, School of Medicine, Los Angeles 90024-6902.
Clin Orthop Relat Res. 1991 Apr(265):137-45.
Seventy-five primary cemented total hip arthroplasties (THAs) were performed in 53 patients with rheumatoid arthritis and juvenile rheumatoid arthritis. All patients were followed for an average of 7.4 years, unless their prosthetic hips failed before that time. Clinical evaluation was based on a 10-point maximum rating scale, and ratings for pain, walking, function, and activity improved from preoperative values to the most recent follow-up examination. Revision THA was performed for aseptic acetabular loosening in four hips, and femoral loosening in one hip. Sepsis occurred in another four hips. Complications of wound healing occurred in 14 hips. Roentgenographic evidence of loosening was seen in six acetabular components, in three femoral components, and in the femoral and acetabular component of one hip; none of these hips have as yet required revision THA. The Kaplan-Meier survivorship analysis revealed a 93% survival probability at seven years, which fell to 77% at 12 years in these patients. A trend was that younger, larger patients had increased failure and component loosening rates. Cemented primary THA has been a satisfactory operation in the rheumatoid patient. The relatively high rate of wound healing problems and sepsis may be due to the systemic immune nature of rheumatoid arthritis; however, 25% of these prosthetic hips either failed or are at risk for future failure. Thus, improved techniques are still necessary to increase the long-term success of THA in the rheumatoid patient.
对53例类风湿性关节炎和青少年类风湿性关节炎患者实施了75例初次骨水泥型全髋关节置换术（THA）。所有患者平均随访7.4年，除非其人工髋关节在此之前出现故障。临床评估基于10分制的最高评分量表，疼痛、行走、功能和活动的评分从术前值改善至最近一次随访检查时的值。因无菌性髋臼松动对4例髋关节进行了翻修THA，因股骨松动对1例髋关节进行了翻修。另外4例髋关节发生了感染。14例髋关节出现伤口愈合并发症。在6个髋臼部件、3个股骨部件以及1例髋关节的股骨和髋臼部件中发现了松动的影像学证据；这些髋关节中尚无需要进行翻修THA的情况。Kaplan-Meier生存分析显示，这些患者7年时的生存概率为93%，12年时降至77%。趋势是年龄较小、体型较大的患者失败率和部件松动率增加。骨水泥型初次THA对类风湿患者来说是一种令人满意的手术。伤口愈合问题和感染的发生率相对较高可能归因于类风湿性关节炎的全身免疫性质；然而，这些人工髋关节中有25%要么已经失败，要么有未来失败的风险。因此，仍需要改进技术以提高THA在类风湿患者中的长期成功率。
