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The Journal of Bone and Joint Surgery, Vol 62, Issue 7 1059-1065, Copyright © 1980 by Journal of Bone and Joint Surgery, Inc
Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis
CS Ranawat, LD Dorr and AE Inglis
Thirty-five total hip arthroplasties done in twenty-five patients with
protrusio acetabuli secondary to rheumatoid arthritis were reviewed. There
was an average follow-up of 4.3 years, with a range of three to seven
years. The results were rated as excellent or good in 66 per cent, fair in
26 per cent, and poor in 8 per cent. Although 100 per cent demonstrated
cementbone interface demarcation around the acetabular component, only 10
per cent showed progression of the line of demarcation to two millimeters
and one had acetabular loosening with migration. Eight per cent showed
femoral loosening or subsidence; 8 per cent, calcar resorption; and 6 per
cent, a receding cortex with cystic changes. Twenty-three per cent had
nonunion of the greater torchanter after trochanteric osteotomy. Type-III
cement-bone interface demarcation was present around the acetabular
component was positioned one centimeter superiorly or medially beyond the
anatomical position, as estimated by the method described. In thirteen hips
in which the acetabular component was positioned within five millimeters of
the anatomical position, no Type-III demarcation was present. Better
fixation and position of the acetabular component is achieved by the use of
a bone graft or a special titanium perforated-sheet mesh, or both, or by an
acetabular shell. The use of three wires improved trochanteric fixation.
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