OrthoNet

Approach to Inflammatory Arthritis - Hip Arthritis

- rheumatoids get concentric wear with erosive changes, and end up with protrusio which tends to be progressive
- bone turnover has been shown to be higher in the peri-articular area - be wary of trying non-cemented techniques, because you may not be able to depend on bone ingrowth.
- in general, rheumatoids have shown increased rates of loosening of the femoral and acetabular components
- they also have increased risk of infection

- there is NO ROLE FOR OSTEOTOMY in this patient population
- technically, be wary of the protrusio - may have to do in-situ osteotomy of the femoral neck; be careful about dislocating the bone - it is very soft and is at risk of fracture; be careful about doing trochanteric osteotomies or slides - the bony healing is not optimal in the rheumatoids and you may precipitate a nonunion.
- the gold standard is cemented fixation, just because their bone is kinda hard to depend on for bony ingrowth
- DO NOT ATTEMPT INTERNAL FIXATION OF RHEUMATOID FEMORAL NECK FRACTURES UNLESS COMPLETELY UNDISPLACED - they DO NOT heal reliably and are better served with THA.

- beware high incidence of HO in ank sponds - be prepared for XRT or NSAIDS postop
- be wary of infection postop - these patients should all get prophylactic antibiotics before dental work, colonoscopy, or other procedures that may involve transient bacteremia
- Kephlex - 500 mg 1 hour preop, then 1 hour postop
- clindamycin if PCN allergic