Abstract
Introduction
The decreased bone mass or local osteoporosis at the proximal femur is often recognized in patients of rheumatoid arthritis (RA). In total hip arthroplasty (THA), the cancellous bone will be lost when rasping technique is applied for the preparation of stem insertion. In addition, cutting or elongation for contracted muscles around the hip joint can be required to insert the stem. To avoid these problems, the non-broaching, non-rasping impaction technique for the stems was applied in THA for the patients with RA. We report clinical and radiographic results of this method.
Materials and Methods
In surgery, the femoral neck was cut and prepared without using a box chisel, reamer or broaches, instead, a series of trial stems were used with the method of impaction technique. After impaction of cancellous bone with the final size of the trial stem, the stem is fixed by bone cement without taking any cement mantle. Full weight bearing was allowed for all patients from the next day of the surgery. We investigated short-term clinical and radiographic results and the incidence of complication that was related to this technique. Post-operative radiological results with the minimum follow-up of 12 months after surgery were analyzed in 31 joints (25 cases) with this technique. The mean age at the time of surgery was 66.3 years (46∼82). The mean duration after surgery was 62 months (14∼108).
Results
No case showed hypotension, decrease of saturation of oxygen concentration during this technique in surgery. Neither pulmonary embolism nor venous thrombosis of the leg was recognized in those cases. All cases showed good walking performance and did not show any hip and thigh pain at the time of follow up. The preoperative mean HHS score was 32.7 (±12.1) and improved to 79.4 (±11.7) at the time of follow up. Although two cases showed slight subsidence of the stem, no case showed the development of the loosening or any adverse effect such as radiolucent line, breakage of the bone cement, and any migration around the stem at the time of follow up.
Conclusion
Although the number of our cases is small and also the follow up period is short, the non-broaching, non-rasping impaction method for stem in THA is thought to be better technique to preserve cancellous bone of the proximal femur, to avoid cutting or elongation of muscles around the hip joint, and to obtain good implant fixation for the patients with osteoporotic proximal femur.
