Polyarthritis and hip replacement

Polyarticular septic arthritis is an underappreciated clinical entity. Pre-existing joint diseases, such as osteoarthritis and rheumatoid arthritis have been shown to be risk factors for septic arthritis. However, there is a paucity of data in the literature regarding the risk of septic arthritis in those patients with enteropathic arthritis. Here, we describe the case of a 47-year-old female with a background history of ulcerative colitis who presented with difficulty mobilising and pain in the hips associated with lethargy, fever and a significant inflammatory response...

BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease characterized by polyarthritis with progressive articular wear, immunologic abnormalities and increasing physical limitation. Surgical correction with hip replacement comes as a successful solution for patients with advanced articular destruction. Following intervention, surgical site infection (SSI), venous thromboembolism, sepsis, renal and major cardiovascular complications are among the most cited in the literature...

Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal-recessive disorder. The polyarthritis of PPD has been detailed before. However, the spinal disorder and surgical treatment been rarely mentioned. A 44-year-old patient who has been misdiagnosed as juvenile rheumatoid arthritis (JRA) and given unilateral total hip replacement yet, suffers mainly from severe spinal disorder this time. The platyspondyly, Scheuermann-like lesions of the spine and JRA-like features of the peripheral joints were found on radiographic films, combining negative inflammatory and rheumatoid factors, which most suggested the diagnosis of PPD...

Multicentric reticulohistiocytosis is a rare multisystem disorder of unknown etiology that is characterized by erosive polyarthritis and papulonodular lesions on the skin, mucous membranes, and internal organs. We report the case of a 54-year-old female who was misdiagnosed as having rheumatoid arthritis and underwent numerous joint replacement surgeries for progressively destructive arthritis in her hands, shoulders, hips, and knees. The patient finally received a diagnosis of multicentric reticulohistiocytosis after histopathological examination of the patient's left knee arthroplasty which revealed a diffuse histiocytic infiltrate, multinucleated giant cells, and finely granulated eosinophilic cytoplasm with a ground-glass appearance...

Juvenile Idiopathic Arthritis (JIA) and Familial Mediterranean Fever (FMF) may involve the same population of children and be confused at times. In a cohort of 350 consecutive FMF patients followed by us, 98 had onset before 10 years of age and, of those, JIA was present in 3. All three had the M694 V mutation of the MEFV gene and were of North African ancestry. The prognosis of these 3 was extremely poor: one developed bilateral knee osteonecrosis with total joint replacement, repeated ileal obstruction with small bowel resection, renal failure and sterility due to amyloidosis and osteoporotic fractures and died at 42 years of age; a second developed deforming erosive arthropathy and underwent bilateral total hip replacement; the third developed severe erosive polyarthritis and also underwent bilateral hip replacements...

The authors report 5 cases of Still's disease in adults whose symptoms were mainly characterised by high fever, transient exanthema, polyarthralgia and/or polyarthritis, lymphoadenomegaly, splenomegaly and neutrophil leukocytosis. Assays for leukocytosis were positive, as were those for inflammatory markers and serum ferritin was also high in all 3 patients in which it assayed. On the contrary, serum ferritin latex test, Waaler-Rose reaction and all other tests commonly used to diagnose long-term fevers were all negative...

UNLABELLED: As a part of long-term follow up (I) of 544 cemented Müller-curved stem total hip replacements (THR), implanted 1977 to 1983, 207 THR in 163 patients with rheumatoid arthritis (RA) were evaluated 9 to 15 years (11 on an average) postoperatively. The feed back rate was 96.9% so the results are very reliable. 18 cups were loosened (13 already changed), but no stem had to be changed for aseptic loosening. 2 THR (1.0%) had to be revised because of deep infection. Survival rate of Kaplan and Meier for aseptic loosening was 94...

Extreme changes of the hip joint often require individual technical supplements in addition to the endoprosthesis. But the base of success are procedures using a model of prosthesis and a technique that are matured. This is available e.g. with the old M. E. Müller curved stem hip joint prosthesis. In special cases of extreme changes or damage of the proximal femur we perform in artificial joint-replacement of the hip or changing of prostheses a special kind of operative treatment. This is a combination of the Original-M...

A review of 62 operated cases with osteoarthritis (OA) indicated clinical evidence of polyarthritis in over 80%. In most cases features of generalized osteoarthritis (GOA) were found. Hand joint arthritis was prominent but, along with the other affected joints, usually asymptomatic. The coexistence of knee disease in cases with hip arthritis and the low incidence of hip changes in those with knee involvement suggest differences in cause for hip disease. These data indicate that the concept of OA as an oligoarticular lesion induced by mechanical or aging processes is inappropriate in a major proportion of knee and hip cases that present for joint replacement...

Rheumatoid arthritis already can lead to an extreme limited range of motion of the whole patient in an early age. A female patient of 39 years has been immobilized for a period of about 6 years. By accident she was suffering too from multiple fractures, especially of both femora and both elbow-joints. Rheumatoid arthritis and traumatic lesions lead to incommon surgical procedures. Both hip-, both elbow- and both kneejoints, regarding to the fractures, were replaced during three operation periods. Within half a year the patient was far extending independent of nursing and able to walk again...

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No abstract text is available yet for this article.

The authors report 6 cases of hip disease with macrocavities during ankylosing spondylarthritis, including 5 cases from a series of 57 coxites which occurred in 34 patients out of 340 ankylosing spondylarthritis, observed at Hospital Begin, between 1973 and 1982. In light of their observations, they propose a classification of the hip manifestations of ankylosing spondylarthritis. The hip involvement with microcavities in ankylosing spondyloarthritis is quite different from coxites with macrocavities present in rheumatoid polyarthritis, and represent more likely a post-inflammatory arthritic type of hip disease than a particular form of coxitis...

The hip with rheumatoid arthritis (RA) is characterized by reduced bone resistance. Protrusion, fatigue fractures and femoral head collapse are the typical consequences. The survival rate of total hip prostheses in hips with RA seems to be higher than for hips with osteoarthritis (OA), possibly due to lower demands. When isolated loosening of the acetabular and femoral component are compared, there is a definite shift towards acetabular loosening in RA compared to OA. This is definitely due to the reduction in the mentioned bone resistance at the acetabular level...

The Müller acetabular reinforcement ring has proven very useful, especially in total hip revision when the bone of the acetabulum is of poor quality or deficient. However, the acetabular reinforcement ring may also be indicated in primary total hip replacement, especially in the case of poor quality bone in the acetabular bone stock, e.g. in chronic polyarthritis or protrusio acetabuli, or of deficient morphology of the acetabulum, e.g. in hip dysplasia. We analysed the results recorded in 145 patients operated on between 1977 and April 1983...

We report the case history of a 57 year old man who has suffered from typical deforming, relapsing polychondritis for 13 years. He has also developed erosive destructive seronegative polyarthritis involving some of his distal interphalangeal, proximal interphalangeal, metacarpophalangeal, intercarpal, wrist, intertarsal and metatarsophalangeal joints. The distribution of joint involvement in the small joints of the hands and feet is asymmetrical. Both hips and knee joints have also been involved necessitating bilateral total hip and right total knee replacement...

Between 1. 1. 1977 and 30. 6. 1988, 1470 total hip prostheses were implanted at the 1st Orthopedic Clinic in Bad Abbach/Regensburg. In 101 cases (82 patients, average age 54.8 years) the acetabular convexity was built up at the same time. This is considered indicated if the acetabulum is too shallow and thus provides insufficient lateral or dorsolateral countersupport. The main area of indication is dysplasia-coxarthrosis and congenital dislocation of the hip, destructive coxitis in chronic polyarthritis or juvenile chronic arthritis, and loosened prostheses...

The results of total hip replacement in 39 patients 30 years old or younger were evaluated including 67 Charnley low-friction arthroplasties and one McKee total hip arthroplasty. The average age was 25.9 years with an average follow-up of 39 months, the longest being 8 years, 3 months. The diagnoses included rheumatoid arthritis, ankylosing spondylitis, CDH, Still's disease, and a miscellaneous group. Over-all function did not improve as greatly as in the 9 to 10 year series, but this was due to a higher proportion of patients with severely disabling rheumatoid polyarthritis, hemiplegia, severe obesity, or cardiovascular disease...

Arthroplasty of the hip with a pair of locked cupolas uses a metal cupola and a polyethylene cotyloid cupola. Ancillary instrumentation and 3 sets of protheses allow an acrylic fixation using a thin layer of cement. The authors report their experience with 75 surface replacement arthroplasties. The initial complications seem related to errors made in at the outset in drilling the femur, thereby compromising the solidity of the neck and the vascularization of the head. These results can be transposed upon the case of total conventional prothesis...

Gamma-GT, alcaline phosphatase and other parameters of abnormal liver functions were estimated in 54 consecutive in-patients having active RA but without a previous history or clinical signs of liver disease, and compared with a matched control group, suffering from degenerative rheumatic disease. There was a slight to moderate elevation of gamma-GT in 40.4% of the RA-patients (mean value 27.2 IU/l) and in 32.1% (mean value 22.3 IU/l) of the control group, respectively. The difference was not significant. Abnormal values in the control group occurred mainly in patients with peri-arthropathia of the shoulder, before mobilisation under anaethetic (3 of 5) and - coxarthrosis before total hip replacement (4 of 12)...