Total hip arthroplasty in rapidly progressive osteoarthritis of the hip: clinical and radiological outcome of a consecutive series of patients

Abstract

Rapidly progressive osteoarthritis (RPOA) is an uncommon subset of osteoarthritis (OA) characterized by rapid joint degeneration and destruction. The treatment of choice for these patients has traditionally been total hip arthroplasty (THA) because nonoperative treatments modalities are not effective. RPOA can lead to acetabular bone loss and consequently intraoperative technical difficulties making joint reconstruction in such patients a challenge for the surgeon. The purpose of this study was to determine the clinical and radiological results of patients suffering from RPOA and treated with hybrid or cementless THA at a single institution. We retrospectively review of all patients who underwent THA for RPOA from January 2011 to December 2016. Twenty-three hips in twenty-one patients were included in this study, with a mean age at surgery of 74 years (range, 41-82) and a mean follow-up of 30 months (range, 24-60). In all patients an uncemented cup, either plasma-spray or trabecular titanium, was implanted. In eighteen cases a cemented femoral stem was used. In eight cases autologous bone graft was used to replace the acetabular defect. Radiographic and clinical follow-up was performed at six months postoperatively, twelve months and yearly thereafter. At radiographic follow-up, no signs of prosthetic loosening or migration were seen. Harris Hip Score improved from 65.3 preoperatively to 89.2 at latest follow-up. The use of both hybrid and uncemented THA in the treatment of RPOA was found to be successful in our patients with a mean 30 months follow-up. Hemispherical cementless cups with both plasma spray and high porosity outer surface (used in the worse cases) were effective in getting primary stability and bone ingrowth.