3rd National Rheumatology Congress of Kosova with International participants: November 3-4, 2016 Emerald Hotel, Prishtina, KosovoReumatology 2016 COMPLICATIONS OF TOTAL HIP ARTHROPLASTY IN PATIENTS WITH RHEUMATHOID ARTHRITIS VERSUS OSTEOARTHRITIS Cen Bytyqi, Faton Morina, Arber Tolaj, Davud Xhigoli, Haki Prebreza, Nderim Salihaj Reconstructiv Department, Orthopaedic Clinic, University Clinical Center, Prishtina

Rheumathoid arthritis (RA) RA is an autoimune disease, which affects about 1% of general population. It is more common in women and can occur at any age. It tends to cause inflammation in multiple joints and in severe cases this leads to progressive joint destruction.

The statistical analysis of RA by Faning in 1950 showed hip changed in 16% of 532 patients, while Forestier et al. in 1951 found hip involvement in 10% of patients at first examination.

Rheumathoid arthritis (RA) In the last decade the treatment of RA has been revolutionized due to increased understanding of its pathology and in particular the key roles of B-cells, T-cells and inflammatory cytokines leading to more aggressive use of the older Disease Modifying Anti-Rheumatic Drugs (DMARDs) such as methotrexate (MTX) and the development of new biologic therapies specifically targeted at these inflammatory cells and cytokines.(Brennan FM, McInnes IB. Evidence that cytokines play a role in rheumatoid arthritis. J Clin Invest 2008, 118: 3537-45.)

The need for early treatment Pain and disability in RA arise from the combination of active inflammation and erosive damage within joints which, if uncontrolled, can develop within the first year of disease.

RA Diagnosis Early treatment requires early diagnosis RA classically presents as a peripheral, symmetrical polyarthritis, with pain, swelling and stiffness of the affected joints It rarely presents as a monoarthritis.

Generally less severe than RA Caused by wear and tear on the body RHEUMATOID ARTHRITIS OSTEOARTHRITIS More severe than OA Caused by immune system attacking the body Can affect people of any age, but most commonly affects those between ages 20 and 60 Symptoms can be felt throughout the entire body Affects more women than man Generally less severe than RA Caused by wear and tear on the body Generally affects people over age 40 Usually only affects the joints Commonly found in both men and women

However, some complications have significant consequences, including Total Hip Arthroplasty (THA) considered one of the most successful operation for end-stage arthritis of the hip. However, some complications have significant consequences, including early revision, infection or dislocation, venous thromboembolism, and death.

This success is reflected in the increasing rates of total hip arthroplasty. Outcome following THA are generally excellent, with low complication rates. M. B. 28 vj.

Hip Replacement Components Acetabular component-consists of two components Cup-usually made of titanium Liner-can be plastic, metal or ceramic Femoral components Head Neck Stem

Objectives: We understood the present study to compare the complications following THA in patients with RA versus OA using systemic literature review.

Most evidence regarding complications following THA are based on patients with osteoarthritis (OA); less is known about outcomes in rheumathoid arthritis (RA).

Condensation, geodes , osteophytes

Osteonekroze

Osteonekroze

Acetabular protrusio

Using epidemiologic and outcomes studies in the literature, many arthroplasty studies in the past had a small sample size, used non validated outcomes and/or were single center studies.

Methods: Studies of various THA complications in patients with RA in comparision to patients with OA, were evaluated. The following complications were included in the assessment: Dislocation after THA Infection Revision Mortality Venous thromboembolic event within 90 days of surgery.

Results: Hip dislocation. Meta-analysis of five studies revealed an increased risk of hip dislocation with 5 years of THA in patients with RA relative to those with OA.

Infection Infection. Compared with OA controls, RA patients had higher odds of infection in the first year. Among those with RA, increased infection risk was associated with prior infection in the replaced joint, prior infection in any joint, and longer duration of operation time.

Hip revision Hip revision at ≤ 5 years. Meta-analysis of 4 studies that reported comparative data revealed increased odds of early revision among RA patients versus OA patients.

Mortality Mortality within 90 days of THA. Meta-analysis of 2 studies revealed no difference between RA and OA patients in the odds of mortality within 90 days of THA.

Venous thromboembolism with 90 days of THA. Meta-analysis of 2 studies revealed no difference in odds of venous thromboembolic events within 90 days of THA in patients with RA versus those with OA.

Problems relate to positioning of the patient, femoral neck cut, original joint line identification, acetabular component positioning, and adequate release of soft tissues.

Osteonekroze bilaterale. PTK e dyanshme. R.C. 40 vj. Osteonekroze bilaterale. PTK e dyanshme.

Arthroplasty Outcomes Are Improving, but Why Isn’t My Patients With Reumathoid Arthritis Doing as Well? Jasvinder A. Singh. Arthritis Rheumatol. Author manuscript; available in PMC 2015 Feb 1. Ravi et al. reported that risks of infection after TKA and dislocation after THA were higher in patients with RA than in those with OA. Ravi et al. Increased risk of complications following total joint arthroplasty in patients with RA. Arthritis Rheumatol 2014; 66:254-63.