[Primary total hip arthroplasty in patients with rheumatoid arthritis].

Total hip arthroplasty has become a successful way of treating the painful and destroyed hip joint in the patient with rheumatoid arthritis (RA). Two hundred twenty (135 cemented and 85 noncemented) total hip arthroplasties were performed in 180 patients with rheumatoid arthritis. The average age was 48.61 years and the average follow-up was 8.4 years. Clinical evaluation was based on a Harris hip score that showed significant improvement in pain and function preoperatively compared with pain and function at followup. There were two deep infections requiring removal of the prosthesis. Four cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. Three acetabular rings were revised due to aseptic loosening. The relatively inferior results of total hip arthroplasty among RA patients is due not only to fixation method, but also to the poorer bone quality and weakening musculature. The results in these patients suggest that cementless total hip arthroplasty might become a successful way of treating the destroyed hip joint in the patient with rheumatoid artritis.

Does tuberculosis after kidney transplantation follow the trend of tuberculosis in general population?

Despite improvement in graft survival, infection continues to be an important cause of morbidity and mortality after kidney transplantation. We analyzed the clinical courses and outcomes of 16 transplanted patients with positive cultures for mycobacterium tuberculosis. In the course of a 20 year period, there were 13 cases of tuberculosis registered that developed in 456 patients who underwent kidney transplantation in our department, and in three refugees transplanted in other centers (a prevalence of 3.13%). Five of them developed tuberculous infections during 1997. Five patients had residual tuberculosis in preoperative chest X-ray, and specific pyelonephritis as an underlying kidney disease in two of them. All patients with treated with triple immunosuppressives. Before tuberculosis onset, 14 patients experienced one or more episodes of acute rejection and were treated with steroid pulses, ALG or OKT3. Tuberculosis was diagnosed after a period of 1.5 months to 10 years after transplantation. At the time of an infection, the graft function was normal in eight patients and chronic graft failure was evident in eight patients (sCr 210-700 micromol/L). The infection was pulmonary in 12 patients; urinary in two; disseminated in two; pulmonary and urinary, pulmonary and intestinal, and pancytopenia in one patient. All patients were treated with rifampicin and isoniazid in addition to ethambutol for the first two-month period. Treatment lasted from 1-22 months. With 14 patients favorable microbiological responses were registered. Two patients died within the first six months (both with disseminated disease), and the mortality rate was 14.3%. Throughout the followup period, the graft function remained stable and normal in eight patients who had normal graft function at the time of infection onset. Although six patients recovered, progressive graft failure developed and hemodialysis was restarted in one patient two months after antituberculous therapy introduction, and in two patients three years later. Four patients died 2-14 months after AT therapy withdrawal. The causes of death were severe liver failure, cerebrovascular insult and CMV.