臼底突出型リウマチ股に対するセメントレス人工股関節置換術の術後成績

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  • Surgical Results of Cementless Total Hip Arthroplasty with Bone Grafting for Rheumatoid Hip Protrusio Acetabuli.

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We studied the surgical results (1-7 years) of cementless total hip arthroplasty (THA) with bone grafting for hip joints with rheumatoid arthritis (RA) accompanying protrusio acetabuli. Of the 154 hips that underwent THA for RA, 36 hips among 31 patients were protrusio acetabuli types whereby the non-loaded site of the resected femoral head was sliced, bone was grafted at the acetabular fossa, and the cup was fixed without bone cement. Except for one case, all were late stage RA, and in most cases surgery was performed as part of multiple replacement arthroplasty. Clinical findings during follow-up showed that the mean JOA score before surgery of 32.1 improved to a mean of 84.3 during the survey period, which indicated good improvement in hip joint function. Practical walking was not possible in half of the cases before surgery, but all patients except one during the survey period were able to maintain practical walking ability. Protrusion distance plus at least 1 mm was determined by X-ray as protrusio acetabuli, but during the survey period minus 8 mm was the mean, and good cup positioning was maintained. The grafted bone took hold without any large changes noted in the cup setting angle. Clear loosening was noted in only one hip in which there was insufficient impact of the grafted bone during surgery, and a radiolucent line of no more than 1 mm was seen in only four hips.Although these are interim results, they indicate the safety and effectiveness of this procedure over the long term. It is not rare in cases of RA for THA to be unavoidable even in young persons. Considering the probability of re-implantation in future, the selection of cementless THA is thought to be appropriate. If adequate bone grafting is performed in combination in the RA hip joint with protrusio acetabuli, it is possible to position a cementless cup, and this is considered a useful method.

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