The Journal of Bone and Joint Surgery, Vol 68, Issue 4 502-508, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Total hip arthroplasty in juvenile rheumatoid arthritis. Two to eleven-year results
PF Lachiewicz, B McCaskill, A Inglis, CS Ranawat and BD Rosenstein
From 1971 to 1980, forty-five patients with juvenile rheumatoid arthritis
had eighty-three cemented total hip replacements at The Hospital for
Special Surgery and North Carolina Memorial Hospital. Thirty-four of these
patients, with sixty-two involved hips, returned for examination and
radiographs. The average age of these thirty-four patients at the time of
surgery was twenty-six years, and twenty-seven of them, with forty-nine
involved hips, were thirty years old or less. The average length of
follow-up was six years (range, two to eleven years), with forty-one hips
having been followed for five to eleven years. According to The Hospital
for Special Surgery hip-rating system, thirty hips were rated excellent;
nineteen, good; nine, fair; and four, poor. Of the four hips with a poor
result, two (in the same patient) had severe heterotopic ossification with
ankylosis postoperatively, and two had required revision: one for
acetabular loosening six years after replacement and the other for a broken
stem of the femoral component ten years postoperatively. Radiographic
review of the sixty-two hips demonstrated progressive radiolucencies or
migration of 26 per cent of the acetabular components and 8 per cent of the
femoral components. The frequency of acetabular migration or progressive
radiolucencies was related to the postoperative position of the component
relative to the position of the true acetabulum. These results were
somewhat better than those in other reports on cemented total hip
replacement in young patients. The difference is probably related to the
lower average weight and decreased activity level of patients with juvenile
rheumatoid arthritis.
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