- See:
rheumatoid arthritis
- Discussion:
-
rheumatoid cervical spine:
- ensure that anesthesia is prepared for possible need for bronchoscopic intubation;
-
total hip arthroplasty in rheumatoid arthritis: (see
total hip replacement);
-
protrusio acetabuli is common and is often progressive;
- many authors recommend stopping
methotrexate 2 weeks before surgery although this may be controversial;
- most of these patients will be on a NSAID and/or steroids;
- these medications may both interfere with bone growth, and therefore they should be held for 6 weeks postop
when patients are to receive a press fit stem;
- withholding NSAIDS or steroids in a RA patient, however, often will provoke a serious arthritic flare;
- if a cemented component is to be used, NSAIDS and steroids need not be discontinued;
- cemented implants:
- in the study by Creighton et al. 1998, 103 hips were followed for a minimum of 10 years.
- 7% of hips were revised (due to infection, dislocation, or loosening (2 patients));
- 8% of hips showed acetabular loosening and 2% showed femoral loosening.
- references:
- Total hip arthroplasty with cement in patients who have rheumatoid arthritis. A minimum ten year follow up study.
MG Creighton MD et al.
JBJS. Vol 80-A. No 10. Oct 1998. p 1439.
- Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. CS Ranawat et al.
JBJS 62-A. 1980. p 1059-1065.
- Should methotrexate be discontinued before elective orthopaedic surgery in patients
with rheumatoid arthritis.
SL Bridges et al. J. Rheumatology. Vol 18. 1991.
p 984-988.
- Local infectious complications following large joint replacement in rheumatoid arthritis patients treated with methotrexate versus those not treated with methotrexate.
RS Perhala et al.
Arthritis Rheum.
Vol 34. 1991. p 146-152.
-
juvenile rheumatoid arthritis:
- references:
-
Total hip arthroplasty in juvenile rheumatoid arthritis. Two to eleven-year results.
-
Total hip and knee arthroplasty in juvenile rheumatoid arthritis.
-
Total hip arthroplasty in juvenile rheumatoid arthritis.
- Management of Femoral Neck Frx in RA:
- indicated for patients w/
rheumatoid arthritis and/or concomitant hip arthrosis;
- patients should be aware of a relatively high complication rate (10% will dislocate);
- risk of dislocation was dramatically reduced using the Hardinge approach (3/40 hips) versus the posterior approach (4/17 hips);
- references:
-
A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck.
-
Secondary total hip replacement after fractures of the femoral neck.
-
Total hip arthroplasty after acute displaced femoral neck fractures.
-
Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement.
-
Total hip arthroplasty following failed internal fixation of hip fractures.
- Treatment of intracapsular hip fractures with total hip arthroplasty in rheumatoid arthritis.
Asai et al. Bull Hosp Joint Dis. Vol 53. 1993. p 29-33.
-
The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison.
-
Treatment of acute femoral neck fractures with total hip arthroplasty.
- Failure of internal fixation of displaced femoral neck fractures in rheumatoid arthritis.
E Bogoch et al.
JBJS. Vol 73-B. 1991. p 7-10.
- Total hip arthroplasty for the treatment of an acute fracture of the femoral neck.
BP Lee MD et al.
JBJS Vol 80-A. No 1. Jan 1998. p 70.
