Anti-rheumatic therapy effecting clinical outcomes of total hip arthroplasty

Introduction Total hip arthroplasty (THA) is an effective treatment for end-stage hip joint involvement in patients with rheumatoid arthritis (RA), reducing pain and improving function. However, systemic inflammation, secondary osteoporosis, and the specific nature of antirheumatic therapy can complicate surgical treatment of the patients. Understanding the interrelationships between standard therapy options is crucial for optimizing perioperative management and improving clinical outcomes of THA.

The objective was to evaluate the impact of different variants of disease-modifying anti-rheumatic therapy on postoperative outcomes of THA patients with rheumatoid arthritis.

Material and methods A review of 314 clinical cases of primary THA was performed. The study included patients with RA (n = 194) and involutional arthrosis (IA) (n = 120). The parameters assessed included radiographic changes (Kellgren-Lawrence and Paprosky classifications, cortical index), surgical treatment, intraoperative blood loss, surgical outcomes, complication rate, pain dynamics evaluated with VAS, joint function assessed with the Harris Hip Score, RA severity assessment using the DAS28, and the quality of life (QoL) using the HAQ questionnaire.

Results RA patients were characterized by more pronounced acetabular defects and a reduced cortical index compared to IA patients (p < 0.0001). The use of disease-modifying antirheumatic drugs was associated with better bone structure preservation, while long-term glucocorticosteroid therapy was associated with worsening radiographic parameters and greater blood loss. Intraoperative blood loss was higher in RA with the use of glucocorticosteroids and nonsteroidal anti-inflammatory drugs. Both groups showed improved clinical outcomes, decreased pain, and improved joint function at three months of THA; however, IA patients achieved more significant results.

Discussion The findings suggested the key role of systemic inflammation and the nature of antirheumatic therapy in determining surgical risks and functional outcomes of endovascular knee replacement. The type of antirheumatic therapy effecting intraoperative features of endovascular knee replacement and surgical outcomes were also highlighted.

Conclusion THA is a surgical treatment modality that can improve clinical, functional outcomes and quality of life of RA patients. Long-term steroid therapy has a detrimental effect on bone tissue, complicating the surgery and increasing intraoperative blood loss.

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