Hip arthroplasty in patients with rheumatoid arthritis

Abstract

Introduction. The literature review deals with the current state of the problem of the hip replacement (HR), in patients with rheumatoid arthritis (RA) are considered in order to systematize the accumulated experience. Materials and methods. A search was conducted for relevant scientific publications over the past ten years in the databases of evidence-based medicine Cochrane Lirary, PubMed and the electronic scientific library e-library. According to the selected keywords, 100 publications were selected and analyzed. Results and discussion. RA is a systemic autoimmune disease characterized by synovial inflammation, symmetrical erosive-destructive polyarthritis, progressive destruction of the joints with the development of severe deformities, as well as a wide range of extra-articular somatic and hematological manifestations. It was revealed that HR allows you to restore musculoskeletal function and significantly reduce pain, but in patients with RA it has a large percentage of local and general complications. As a result of severe connective tissue lesions, long-term hormonal and immunosuppressive therapy, the structure of bone tissue and the anatomy of articulated bones change significantly. The protrusio acetabula with significant medialization of the center of rotation of the hip joint require a special reconstructive hip replacement. The minimizing surgical trauma, the osteoplasty protrusion defect of acetabula, stability fixation of the prosthesis, specialized preoperative preparation, reducing the activity of the inflammatory process, the prevention of periprosthetic infection and the prevention of venous thromboembolism, the correction of anemia are becoming increasingly relevant. Conclusion. It has been established that the normalization of the joint rotation center, the restoration of the offset with bone grafting of the protrusion defect, reliable primary fixation of the cementless acetabular component of the prosthesis, provide biomechanical conditions for long-term and painless functioning of the implant. Perioperative management of such patients should include a multidisciplinary approach.