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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.

Original publication

DOI

10.1080/03009740310003910

Type

Journal article

Journal

Scandinavian journal of rheumatology

Publication Date

01/2003

Volume

32

Pages

281 - 286

Addresses

Department of Surgery, University of Oxford, Nuffield Orthopaedic Centre, Oxford UK.

Keywords

Hip Joint, Joint Capsule, Humans, Spondylitis, Ankylosing, Arthritis, Rheumatoid, Arthritis, Juvenile Rheumatoid, Prosthesis Failure, Arthroplasty, Replacement, Hip, Reoperation, Hip Prosthesis, Adolescent, Adult, Aged, Middle Aged, Female, Male