An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis

International Journal of Rheumatology, Jul 2015

Total hip arthroplasty (THA) has improved the quality of life of patients with hip arthritis. Orthopedic community is striving for excellence to improve surgical techniques and postoperative care. Despite these efforts, patients continue facing postoperative complications. In particular, patients with rheumatoid arthritis display a higher risk of certain complications such as dislocation, periprosthetic infection, and shorter prosthesis durability. In this review we present the current knowledge of hip arthroplasty in patients with rheumatoid arthritis with more insight into common practices and interventions directed at enhancing recovery of these patients and current shortfalls.

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An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis

An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis Mohammad Saeed Mosleh-shirazi,1 Mazin Ibrahim,1 Philip Pastides,2 Wasim Khan,2 and Habib Rahman1 1Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK 2Royal Free London NHS Foundation Trust, London NW3 2QG, UK Received 30 August 2014; Accepted 3 December 2014 Academic Editor: Atif Malik Copyright © 2015 Mohammad Saeed Mosleh-shirazi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Total hip arthroplasty (THA) has improved the quality of life of patients with hip arthritis. Orthopedic community is striving for excellence to improve surgical techniques and postoperative care. Despite these efforts, patients continue facing postoperative complications. In particular, patients with rheumatoid arthritis display a higher risk of certain complications such as dislocation, periprosthetic infection, and shorter prosthesis durability. In this review we present the current knowledge of hip arthroplasty in patients with rheumatoid arthritis with more insight into common practices and interventions directed at enhancing recovery of these patients and current shortfalls. 1. Introduction Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects 2% of women and 0.5% of men in the UK [1, 2]. This disease is characterized by peripheral and systematic polyarthritis, resulting in joint deformity and destruction due to erosion of cartilage and bone [3]. Rheumatoid patients requiring hip arthroplasty are usually younger than patients with osteoarthritis, display chronic systemic inflammation, use immune suppressive and disease-modifying drugs, and frequently develop osteoporosis [4–6]. The goal of treatment for patients suffering from rheumatoid arthritis of the hip is to reduce pain and improve function [7]. These patients are already taking analgesics, NSAID, and immunosuppressive and disease-modifying drugs. However, at advanced stages of the disease, surgical treatments become essential [7]. Once hip is involved in rheumatic disease process the function and mobility of these patients are greatly reduced and these patients go off their feet very quickly. Total hip arthroplasty (THA) is a surgical intervention carried out on end-stage arthritis patients. According to the National Hip and Knee Registry, in 2011, in the UK, hip and knee replacements have increased by 5% and 3.3% compared to 2010. The necessity to assess the rate of developing complications in RA patients can be understood in light of implications it may have on surgical decision-making. In other words, understanding the risk factors involved and higher vulnerability of groups of patients with specific characteristics is a critical factor in determining which patients should receive surgical treatments. In this review we have sought to specifically address causes of complications, benefits and risk involved in undertaking THA, measures aimed at enhancing recovery, and the improvement of quality of life in these patients. Furthermore we will debate common practices and shortfalls in surgical interventions, techniques, and postsurgical care. We searched the literature using electronic medical databases including PUBMED, MEDLINE, and EMBASE up to August 2014 on reports pertaining to current knowledge of the field of total hip arthroplasty (THA) in patients suffering from rheumatoid arthritis (RA). We have used the following keywords: “Arthroplasty,” “Rheumatoid Arthritis,” “Total Hip Arthroplasty,” “Total hip replacement,” “Peri-operative management,” and “Post-operative management.” RA patients undergoing THA treatment can encounter more complications as compared to patients suffering from osteoarthritis (Table 1). Here, we summarize causative factors that may be contributing to the observed complications and also discuss preventative measures and procedures that may minimize such risks. Table 1: Table showing rate of complications in RA patients undergoing THA. 2. Complications of THA in Patients with RA and Causative Factors Contributing to These Complications Despite recent improvement in biological agents and treatment procedures in the field of rheumatology, joint and musculoskeletal deterioration continues to occur in patients with RA, who eventually require joint surgery. In patients with total hip arthroplasty, any of the following complications may be experienced: hip dislocation, requirement of early revision surgery, shorter prosthesis durability, joint infection, venous thromboembolism, and death [8]. Recent reports suggest that patients with RA may be at a greater risk of developing some of these complications. In a large cohort study conducted by Ravi and colleagues, in two age- and s (...truncated)


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Mohammad Saeed Mosleh-shirazi, Mazin Ibrahim, Philip Pastides, Wasim Khan, Habib Rahman. An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis, International Journal of Rheumatology, 2015, 2015, DOI: 10.1155/2015/140143