A correlative study of clinical and histological findings of revision hip arthroplasty for rheumatoid arthritis and inflammatory joint disease.

Journal article

OBJECTIVE: Primary hip arthroplasty in rheumatoid arthritis (RA) and other forms of inflammatory joint disease (IJD) is generally thought to be associated with a less favourable outcome in terms of implant survival and other complications. Whether the duration of implant survival correlates with the degree of rheumatoid-like inflammatory changes in periprosthetic tissues is uncertain. METHODS: Histopathological changes in periprosthetic tissues obtained following revision surgery of 34 total hip replacements on 27 patients with IJD (RA 18 cases: ankylosing spondylitis three cases; juvenile chronic arthritis six cases) were examined. RESULTS: A heavy diffuse lymphocyte and plasma cell infiltrate +/- lymphoid aggregates was noted in 29% of cases in whom the mean implant survival was 5.6 years (range: 2-8 years). Where little or no lymphocytic infiltrate was noted in periprosthetic tissues, the mean implant survival was 8.6 years (range: 1-17 years). Revision arthroplasty was not undertaken for early or late infection of a primary hip replacement. CONCLUSIONS: Our findings indicate that implant survival is less in those cases where there is a heavy lymphocyte and plasma-cell infiltrate in periprosthetic tissues. These findings suggest that the presence of a heavy chronic inflammatory-cell infiltrate in periprosthetic tissues is likely to be a contributory factor in causing early implant failure in RA.

Authors: Petra, M; Diaz, J; McLardy-Smith, P; Murray, D; Gundle, R

• Publication status: Published
• Journal: Scandinavian journal of rheumatology
• Volume: 32
• Issue: 5
• Pages: 281-286
• Publication date: 2003-01-01
• DOI: 10.1080/03009740310003910
• EISSN: 1502-7732
• ISSN: 0300-9742
• Language: English
• Keywords: Spondylitis, Ankylosing; Prosthesis Failure; Middle Aged; Reoperation; Adolescent; Aged; Humans; Adult; Joint Capsule; Arthroplasty, Replacement, Hip; Male; Female; Hip Prosthesis; Arthritis, Rheumatoid; Arthritis, Juvenile Rheumatoid; Hip Joint