[CEMENTLESS TOTAL HIP ARTHROPLASTY AND IMPACTED BONE GRAFTING FOR PROTRUSIO ACETABULI IN PATIENTS WITH RHEUMATOID ARTHRITIS].

OBJECTIVE

To evaluate the effectiveness of total hip arthroplasty (THA) with impacted autologous bone grafting and a cementless cup in the treatment of rheumatoid arthritis (RA) with protrusio acetabuli.

METHODS

Between January 2001 and April 2009, 18 cases (20 hips) of RA with protrusio acetabuli were treated, including 6 males and 12 females with an average age of 46 years (range, 36-62 years). The disease duration was 3-10 years (mean, 6 years). Preoperative Harris score was 40.25 ± 6.68. The protrusio acetabuli was (5.70 ± 4.26) mm. According to Sotelo-Garza and Charnley classification criterion, there were 12 hips of type 1 (protrusio acetabuli 1-5 mm), 5 hips of type 2 (6-15 mm), and 3 hips of type 3 (>15 mm). All patients received THA with impacting bone graft and cementless prosthesis for recovery of acetabular center of rotation.

RESULTS

The average operation time was 74 minutes (range, 48-126 minutes); the average blood loss was 350 mL (range, 150-650 mL). Deep venous thrombosis of lower extremity and poor healing of incision occurred in 3 and 2 cases respectively. Other patients achieved primary healing of incisions. The mean time of follow-up was 108 months (range, 60-156 months). According to X-ray films, bone grafting fusion was observed within 6 months after operation. At last follow-up, the Harris score was 87.20 ± 4.21, showing significant difference when compared with preoperative score (t = -27.68, P = 0.00); the protrusio acetabuli was (-1.11 ± 0.45) mm, showing significant difference when compared with preoperative value (t = 5.66, P = 0.00). No loosening of acetabular components was found.

CONCLUSION

For RA patients with protrusio acetabuli, THA with impacted autologous bone grafting and a cementless cup has satisfactory medium-term effectiveness.