CEMENTLESS TOTAL HIP ARTHROPLASTY AND IMPACTED BONE GRAFTING FOR PROTRUSIO ACETABULI IN PATIENTS WITH RHEUMATOID ARTHRITIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUNing ,  YANGYang , CHENHong , LIWeiqiang , PUBo , LIULuping

Department of Orthopaedics, the Second Hospital Affiliated to Kunming Medical University, Kunming Yunnan, 650101, P. R. China;

Corresponding author：

YANGYang, Email: 874914986@qq.com

Keywords：

Rheumatoid arthritis; Protrusio acetabuli; Impaction bone graft; Cementless cup

DOI：

10.7507/1002-1892.20150034

Video：

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Objective To evaluate the effectiveness of total hip arthroplasty (THA) with impacted autologous bone grafting and a cementless cup in the treatment of rheumatoid arthritis (RA) with protrusio acetabuli. Methods Between January 2001 and April 2009, 18 cases (20 hips) of RA with protrusio acetabuli were treated, including 6 males and 12 females with an average age of 46 years (range, 36-62 years). The disease duration was 3-10 years (mean, 6 years). Preoperative Harris score was 40.25±6.68. The protrusio acetabuli was (5.70±4.26) mm. According to Sotelo-Garza and Charnley classification criterion, there were 12 hips of type 1 (protrusio acetabuli 1-5 mm), 5 hips of type 2 (6-15 mm), and 3 hips of type 3 (>15 mm). All patients received THA with impacting bone graft and cementless prosthesis for recovery of acetabular center of rotation. Results The average operation time was 74 minutes (range, 48-126 minutes); the average blood loss was 350 mL (range, 150-650 mL). Deep venous thrombosis of lower extremity and poor healing of incision occurred in 3 and 2 cases respectively. Other patients achieved primary healing of incisions. The mean time of follow-up was 108 months (range, 60-156 months). According to X-ray films, bone grafting fusion was observed within 6 months after operation. At last follow-up, the Harris score was 87.20±4.21, showing significant difference when compared with preoperative score (t=-27.68, P=0.00); the protrusio acetabuli was (-1.11±0.45) mm, showing significant difference when compared with preoperative value (t=5.66, P=0.00). No loosening of acetabular components was found. Conclusion For RA patients with protrusio acetabuli, THA with impacted autologous bone grafting and a cementless cup has satisfactory medium term effectiveness.

Citation： LUNing, YANGYang, CHENHong, LIWeiqiang, PUBo, LIULuping. CEMENTLESS TOTAL HIP ARTHROPLASTY AND IMPACTED BONE GRAFTING FOR PROTRUSIO ACETABULI IN PATIENTS WITH RHEUMATOID ARTHRITIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 160-162. doi: 10.7507/1002-1892.20150034 Copy

1.	Sotelo-Garza A, Charnley J. The results of Charnley arthroplasty of the hip performed for protrusion acetabuli. Clin Orthop Relat Res, 1978, (132):12-18.
2.	鲁宁, 杨阳, Alejandro González Della Valle, 等. 多重血栓预防方案在髋关节置换中的应用. 实用医学杂志, 2013, 29(14):2325-2327.
3.	Crowninshield RD, Brand RA, Pedersen DR. A stress analysis of acetabular reconstruction in protrusio acetabuli. J Bone Joint Surg (Am), 1983, 65(4):495-499.
4.	Gates HS 3rd, Poletti SC, Callaghan JJ, et al. Radiographic measure-ments in protrusio acetabuli. J Arthroplasty, 1989, 4(4):347-351.
5.	Baghdadi YM, Larson AN, Sierra RJ. Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival. Clin Orthop Relat Res, 2013, 471(10):3251-3259.
6.	Slooff TJ, Huiskes R, van Horn J, et al. Bone grafting in total hip replacement for acetabular protrusion. Acta Orthop Scand, 1984, 55(6):593-596.
7.	Welten ML, Schreurs BW, Buma P, et al. Acetabular reconstruction with impacted morcellized cancellous bone autograft and cemented primary total hip arthroplasty:a 10 to 17-year follow-up study. J Arthroplasty, 2000, 15(7):819-824.
8.	Rosenberg WW, Schreurs BW, de Waal Malefijt MC, et al. Impaceted morsellized bone grafting and cemented primary total hip arthroplasty for acetabular protrusion in patients with rheumatoid arthritis:an 8- to 18-years follow-up study of 36 hips. Acta Orthop Scand, 2000, 71(2):143-146.
9.	Schulte KR, Callaghan JJ, Kelley SS, et al. The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up. The results of one surgeon. J Bone Joint Surg (Am), 1993, 75(7):961-975.
10.	Figueras Coll G, Salazar Fernandez de Erenchu J, RocaBurniol J. Results of acetabular wiremesh and autograft in protrusio acetabuli. Hip Int, 2008, 18(1):23-28.
11.	Garcia-Cimbrelo E, Diaz-Martin A, Madero R, et al. Loosening of the cup after low-friction arthroplasty in patients with acetabular protrusion. The importance of the position of the cup. J Bone Joint Surg (Br), 2000, 82(1):108-115.
12.	马金忠, 朱力波, 桑伟林. 全髋关节置换术治疗髋臼内陷症. 中国矫形外科杂志, 2008, 16(15):1136-1137, 1149.
13.	MullajiAB, Marawar SV. Primary total hip arthroplasty in protrusio acetabuli using impacted morsellized bone grafting and cementless cups:a medium-term radiographic review. J Arthroplasty, 2007, 22(8):1143-1149.
14.	杨序程, 周一新, 唐杞衡,等. 非水泥臼杯处理髋臼内陷的全髋关节置换术. 中国矫形外科杂志, 2011, 19(4):289-291.
15.	唐颂军, 刘伟, 李晓华. 类风湿性关节炎继发髋臼内陷的髋关节置换. 中国组织工程研究, 2013, 17(22):4144-4151.
16.	Mäkelä KT, Eskelinen A, Pulkkinen P, et al. Cemented versus cementless total hip replacement in patients fifty-five years of age or older with rheumatoid arthritis. J Bone Joint Surg (Am), 2011, 93(2):178-186.

1. Sotelo-Garza A, Charnley J. The results of Charnley arthroplasty of the hip performed for protrusion acetabuli. Clin Orthop Relat Res, 1978, (132):12-18.
2. 鲁宁, 杨阳, Alejandro González Della Valle, 等. 多重血栓预防方案在髋关节置换中的应用. 实用医学杂志, 2013, 29(14):2325-2327.
3. Crowninshield RD, Brand RA, Pedersen DR. A stress analysis of acetabular reconstruction in protrusio acetabuli. J Bone Joint Surg (Am), 1983, 65(4):495-499.
4. Gates HS 3rd, Poletti SC, Callaghan JJ, et al. Radiographic measure-ments in protrusio acetabuli. J Arthroplasty, 1989, 4(4):347-351.
5. Baghdadi YM, Larson AN, Sierra RJ. Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival. Clin Orthop Relat Res, 2013, 471(10):3251-3259.
6. Slooff TJ, Huiskes R, van Horn J, et al. Bone grafting in total hip replacement for acetabular protrusion. Acta Orthop Scand, 1984, 55(6):593-596.
7. Welten ML, Schreurs BW, Buma P, et al. Acetabular reconstruction with impacted morcellized cancellous bone autograft and cemented primary total hip arthroplasty:a 10 to 17-year follow-up study. J Arthroplasty, 2000, 15(7):819-824.
8. Rosenberg WW, Schreurs BW, de Waal Malefijt MC, et al. Impaceted morsellized bone grafting and cemented primary total hip arthroplasty for acetabular protrusion in patients with rheumatoid arthritis:an 8- to 18-years follow-up study of 36 hips. Acta Orthop Scand, 2000, 71(2):143-146.
9. Schulte KR, Callaghan JJ, Kelley SS, et al. The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up. The results of one surgeon. J Bone Joint Surg (Am), 1993, 75(7):961-975.
10. Figueras Coll G, Salazar Fernandez de Erenchu J, RocaBurniol J. Results of acetabular wiremesh and autograft in protrusio acetabuli. Hip Int, 2008, 18(1):23-28.
11. Garcia-Cimbrelo E, Diaz-Martin A, Madero R, et al. Loosening of the cup after low-friction arthroplasty in patients with acetabular protrusion. The importance of the position of the cup. J Bone Joint Surg (Br), 2000, 82(1):108-115.
12. 马金忠, 朱力波, 桑伟林. 全髋关节置换术治疗髋臼内陷症. 中国矫形外科杂志, 2008, 16(15):1136-1137, 1149.
13. MullajiAB, Marawar SV. Primary total hip arthroplasty in protrusio acetabuli using impacted morsellized bone grafting and cementless cups:a medium-term radiographic review. J Arthroplasty, 2007, 22(8):1143-1149.
14. 杨序程, 周一新, 唐杞衡,等. 非水泥臼杯处理髋臼内陷的全髋关节置换术. 中国矫形外科杂志, 2011, 19(4):289-291.
15. 唐颂军, 刘伟, 李晓华. 类风湿性关节炎继发髋臼内陷的髋关节置换. 中国组织工程研究, 2013, 17(22):4144-4151.
16. Mäkelä KT, Eskelinen A, Pulkkinen P, et al. Cemented versus cementless total hip replacement in patients fifty-five years of age or older with rheumatoid arthritis. J Bone Joint Surg (Am), 2011, 93(2):178-186.

Chinese Journal of Reparative and Reconstructive Surgery

CEMENTLESS TOTAL HIP ARTHROPLASTY AND IMPACTED BONE GRAFTING FOR PROTRUSIO ACETABULI IN PATIENTS WITH RHEUMATOID ARTHRITIS

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