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
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