| ObjectiveTo investigate the clinical effect of total hip arthroplast(THA)combined with autologous bone grafts for the treatment of acetabular depression(Acetabular subsidence of advanced rheumatoid arthritis)in the treatment of advanced rheumatoid arthritis.MethodsA retrospective analysis of 42 cases(51 hips)with RA hip arthritis and acetabular subsidence in the Department of orthopedics of the Affiliated Hospital of Kunming hospital from January 2014 to December 2016 was retrospectively analyzed.Cases included:rheumatoid arthritis and acetabulum invagination,hip pain and activity limitation seriously affect patients’ normal life or work.Case exclusion criteria:history of infection,history of trauma,history of operation,and sensory dysfunction of lower extremities.The study included 42 patients(51 hips),including 37 women(44 hips),5 males(7 hips),15 left hips,18 right hips,9 bilateral hips.The age of the operation was 42 years old at the age of 42 years,with an average age of 53.6 years.33 cases of rheumatoid arthritis with other joints,5 cases with rheumatic valvular heart disease,2 cases with rheumatoid lung disease,9 cases with rheumatoid subcutaneous nodules,the diagnosis of rheumatoid to operation time was 6 years-54 years,average 31.8 years,6mm-146mm/h,average 52.3mmh,26 cases of rheumatoid factor.Increase。The "4" sign and Trendenleburg sign of hips were positive.Pelvis plain film and CT were used to evaluate acetabular morphology before operation.The relative position of the acetabulum on the Kohler,s line and the acetabular base on the pelvis radiography was judged by the relative position of the acetabular base.The degree of the acetabulum was judged by Sotello-Garza and Charnley classification.The distance of the acetabulum was beyond Kohler and the distance of the s line was divided into 3 degrees.Mild:1-5mm(9 hips),moderate:6-15mm(31 hips),severe:greater than 15mm(11 hips).All patients involved in the experiment had different degrees of acetabulum invagination but no penetration.All patients were treated with biologic total hip prosthesis,including 27 cases(31 hips)with Link prosthesis,15 cases(20 hips)and a diameter of 48-5 6mm.Harris score and SF-36 score were performed before and after operation.The Ranawat trigonometry was used to determine the rotation center of the dissection of the hip joint,the vertical distance and the horizontal distance of the dissected rotation center,the measurement of the lateral femur eccentricity and the length of the affected limb by the unilateral patients.The vertical and horizontal distance of the rotation center,femoral offset,acetabular abduction angle and limb length were measured again after operation.The data were processed by SPSS 21 software package,and the data were used for paired t test.The data were described with mean standard deviation.The results were compared before and after the operation,and the difference was statistically significant with the difference of P<0.05.ResultsAll patients were healed by I,and 9 patients(10 hips)had mild swelling of the lower extremities.A total of 42 patients(51 hips)were followed up for 12～35 months,with an average of 19.6 months.The claudication gait of the patients was obviously improved.The X-ray examination showed no loosening and sinking of the prosthesis during the follow-up period.There was no bright line around the prosthesis.All prostheses were well stabilized.The bone trabecula appeared on the base of the acetabulum and the autograft bone,and the transplanted bone was good.The operative time was 61-103(82 ± 13.8)min,and intraoperative dominant blood loss was 160-450(235 ± 25.3)ml.The Harris score of the hip joint was(40.49 ± 1.58)before the operation(91.8 ± 2.23)after the operation(P<0.05).The flexion of the affected hip joint was from(44.47 ± 2.39)degrees before the operation to the end of 1(95.61 ± 2.04)degrees(95.61 ± 2.04)(P<0.05).The horizontal and vertical distance of the prosthesis rotation center and the femoral eccentricity of the unilateral femoral prosthesis were(38.35± 1.46)mm,(26.06 ± 0.29)mm and(37.42 ±0.47)mm after the operation.The horizontal and vertical distance of the anatomical rotation center,the lateral femur eccentricity of the unilateral patients(38.47 ± 1.48)mm,(26.03 ± 0.28)mm respectively,were measured before the operation.There was no significant difference in(37.33 ± 0.48)mm(t=-0.60,P>0.05),(t=-0.60,P>0.05),(t=-0.68,P>0.05).There was a statistically significant difference in the SF-36 scores between the preoperative and postoperative follow-up(P<0.05).The postoperative abduction angle of acetabulum was(42.5 ± 3.5)degrees and the reference range of the best abduction angle(400-450)was 96.8%when the acetabular prosthesis was placed.Preoperative limb length(82.30 ± 6.71)cm,postoperative limb length(84.40 ± 6.39)cm,limb lengthening(2.32± 1.50)cm.ConclusionsTotal hip arthroplast(THA)combined with autologous bone compression and bone graft for the treatment of advanced rheumatoid arthritis(Acetabular subsidence of advanced rheumatoid arthritis in the)can lead to a better early therapeutic effect. |
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