Minimum 10-year results of cementless total hip arthroplasty in patients with rheumatoid arthritis

Abstract

Objectives: To retrospectively evaluate the long-term results of cementless total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) and postoperative patient mortality after THA.

Methods: This study included 191 hips in 149 RA patients who underwent cementless THA between 1998 and 2005. Mean age at surgery was 54.2 years, and mean follow-up was 12.6 years. Implant and patient survivorships were determined using the Kaplan–Meier method, and the associated influencing factors were determined.

Results: Implant survivals at 17 years were 99.5% for stems, 93.9% for cups, and 90.8% for liners. Among the liners used, THAs with highly cross-linked polyethylene showed better survivals compared with those with conventional polyethylene and alumina-bearing surface (93.4%, 90.9%, and 52.2%, respectively). A total of 64 deaths occurred; 45 patients died within 10 years and 19 patients died between 10 and 17 years. Malignancy (25.0%) was the leading cause of death, followed by pneumonia (20.8%) and sepsis (20.8%). The patient survival rate was 36.9% at 17 years after THA. Multivariate analysis exhibited that older age at operation and greater dose of concomitant corticosteroid resulted in shorter patient survivals.

Conclusions: Cementless THA worked well in patients with RA. Mortality remained high among RA patients who needed THA.

Keywords:

• Cementless total hip arthroplasty
• Long-term results
• Mortality
• Rheumatoid arthritis

Acknowledgments

We thank Junji Kishimoto, a statistician from the Digital Medicine Initiative, Kyushu University, for his valuable comments and suggestions in regards to the statistical analysis.

Conflict of interest

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (No.15K10450).

Y.N. received speaking fees or honorarium from Chugai Pharmaceutical, Mitsubishi-Tanabe Pharma, Janssen Pharmaceutical, Pfizer, Eisai, AbbVie, Bristol-Myers, Astellas, Santen, Takeda Pharmaceutical, Kyocera, Zimmer and Depuy (Each was unrelated to this work and less than US$2000). H.M. received speaking fees from Chugai Pharmaceutical, Takeda Pharmaceutical, Mitsubishi-Tanabe Pharma, Janssen Pharmaceutical, Pfizer, Eisai, AbbVie, Bristol-Myers, Astellas, Santen. (Each was unrelated to this work and less than US$2000 each). H.Y received speaking fees from Bristol-Myers unrelated to this work. (Each was unrelated to this work and less than US$2000 each). K.O. received speaking fees from Daiichi Sankyo Company, Zimmer, Depuy, Smith & Nephew and Biomet unrelated to this work (Each was unrelated to this work and less than US$2000 each).