Rheumatoid arthritis (RA) of the hip may be treated by replacing the joint with a total hip arthroplasty (THA). However, the socket side of the joint implant sometimes gets infected or comes loose and has to be repaired. The procedure to do this is called acetabular revision.
Acetabular revision in patients with RA is a challenge for the orthopedic doctor. Poor bone quality and loss of bone leaves little for the surgeon to work with. A bone graft may be needed. A new method to do this is called impaction bone grafting. Bone dust and very fine bone shavings are combined to strengthen the weakened bone. The graft is pressed into the hipbone using special surgical tools. The plastic (polyethylene) replacement cup is then cemented in place.
A study from the Netherlands reports the results of this revision method. The authors say that when a THA must be replaced in patients with RA, this form of bone grafting combined with a cemented cup has good results. A small number of patients (35 hips) were followed for an average of 12 years.
The revisions held up well for 90 percent of the patients. Even after five to seven years, the number of infections or loose implants was very low. Some patients had X-ray signs of loosening, but they reported no symptoms or problems. The authors think replacing lost bone is a good solution for patients with RA who need acetabular revision.
B. Willem Schreurs, MD, PhD, et al. Acetabular Revision with Impacted Morselized Cancellous Bone Graft and a Cemented Cup in Patients with Rheumatoid Arthritis. In The Journal of Bone and Joint Surgery. April 2003. Vol. 85-A. No. 4. Pp. 647-652.'