Totaleheupprothesen bij reumatoïde artritis na acetabulumreconstructie met geïmpacteerde botsnippers en een gecementeerde polyethyleenkom: weinig aseptische komloslatingen

To determine the outcome of acetabular reconstructions using the technique of impacted morsellised bone grafts in combination with a cemented cup in patients with rheumatoid arthritis.

Design

Retrospective.

Method

Data were collected from rheumatoid arthritis patients in whom hip arthroplasty and acetabular reconstruction had been carried out, and who were followed up both clinically and radiologically at the St Radboud University Hospital in Nijmegen, the Netherlands: 31 patients in whom 36 prostheses had been placed during primary hip arthroplasties which took place at least eight years previously (in 1979/'88), and 28 patients in whom 35 prostheses had been placed during revision arthroplasties of the hip which were carried out at least three years previously (in 1983/’97). Using Kaplan-Meier analysis, the survival rate of the prostheses was calculated, with ‘cup revision due to aseptic loosening’ as the outcome measure.

Results

Of the 31 patients with a primary hip arthroplasty, three were lost to follow-up and 12 had died. The remaining 16 patients (20 prostheses) were 3 men and 13 women with an average age of 53 years (range: 20-79). The mean follow-up was 12 years (range: 8-18). Aseptic loosening occurred in two patients, 6.5 and 8 years after arthroplasty, respectively. The calculated prosthesis survival rate was 90 (95 CI: 77-100) after 12 years. Five of the 28 patients who had undergone revision arthroplasty of the hip had died; the remaining 23 patients (29 prostheses) were 2 men and 21 women with an average age of 55 years (range: 31-70). The mean follow-up was 7.5 years (range: 3-14). In 6 patients another revision operation was carried out, in 2 because of infection around the prosthesis, in one because of peri-operative stability problems of the acetabular cup, and in 3 because of aseptic loosening. The calculated prosthesis survival rate was 91 (95 CI: 84-95) after 10 years.

Conclusion

The acetabular reconstruction technique resulted in a low incidence of loosening in patients with rheumatoid arthritis in both primary and revision total hip arthroplasty.