Six- to 11-year Results of Total Hip Arthroplasty in Rheumatoid Arthritis

The results of 138 total hip arthroplasties in 98 rheumatoid arthritic patients were reviewed six to 11 years (mean, 7.0 years) after operation. While 96% of the patients were clinically improved as a result of surgery, radiographic analysis suggests that, despite their low functional requirements, this group of patients experiences mechanical loosening and failure with time. Improvements in prosthetic design and cementing technique should contribute to a lowered incidence of mechanical failure in the future. In addition to improvements in technology, the failure rate can be further diminished by recognition of the systemic problems associated with rheumatoid arthritis, e.g., high incidence of infection, osteopenia, and sequelae of multiple joint involvement. In reconstruction of the acetabulum, especially in the presence of protrusio, failure to restore the anatomic position and orientation of the acetabulum predisposes to loosening and migration.