ABSTRACT
A case of refractory rheumatoid arthritis with a rapid destruction of the hip joint and an enlarged iliopsoas bursa is presented. Rapidly destructive coxarthrosis, chondrocalcinosis, suppurative arthritis, and pigmented villonodular synovitis were the differential diagnoses. Radiological examination showed that rheumatoid arthritis was most likely diagnosis. The patient was treated with total hip arthroplasty and etanercept, with good results.
Subject(s)
Arthritis, Rheumatoid/diagnostic imaging , Bursa, Synovial/diagnostic imaging , Hip Joint/diagnostic imaging , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/pathology , Arthritis, Rheumatoid/therapy , Arthroplasty, Replacement, Hip , Bursa, Synovial/pathology , Diagnosis, Differential , Etanercept , Hip Joint/pathology , Hip Joint/surgery , Humans , Immunoglobulin G/therapeutic use , Male , Middle Aged , Radiography , Receptors, Tumor Necrosis Factor/therapeutic use , Treatment OutcomeABSTRACT
Postoperative results and complications of total elbow arthroplasty (TEA) conducted for rheumatoid arthritis (RA) patients at our institute were studied. Primary TEAs were performed in 72 patients. The mean follow-up period was 3.5 years. Three types of prostheses were implanted: JACE prosthesis in 34 elbows, STABLE prosthesis in 13 elbows, and KUDO prosthesis (type 5) in 32 elbows. The outcome was evaluated by the change in the range of motion and the Japanese Orthopaedic Association functional evaluation score for the elbow joint (JOA score). The arc of motion and the JOA score at discharge and at final examination significantly improved in patients with the three types of prosthesis. The loosening rates for the JACE, STABLE and KUDO prostheses were 15, 23, and 0%, respectively, although the follow-up periods were different. The loosening rate decreased to 2.5% when the humeral component was fixed with cement. Intraoperative fractures occurred in eight (10.1%) elbows and ulnar nerve palsy in six. Deep infection developed in three (4.8%) elbows and was treated by removing the prosthesis. Although there were considerable complications, the marked improvements in pain and function favor TEA in patients with rheumatoid elbow.