Successful total hip arthroplasty in patients with anca-associated systemic vasculitis
The retrospective study enrolled 8 patients with ANCA-associated systemic vasculitis (AASV) and hip joint (HJ) injury with indications for total hip arthroplasty (HA); a total of 11 HJs were operated on. The patients’ median age at the time of the first HA was 54 [31; 76] years. The median duration...
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| Format: | Article |
| Language: | Russian |
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IMA PRESS LLC
2019-11-01
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| Series: | Научно-практическая ревматология |
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| Online Access: | https://rsp.mediar-press.net/rsp/article/view/2784 |
| _version_ | 1797862658942173184 |
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| author | T. V. Beketova E. A. Naryshkin E. V. Arsenyev M. A. Makarov |
| author_facet | T. V. Beketova E. A. Naryshkin E. V. Arsenyev M. A. Makarov |
| author_sort | T. V. Beketova |
| collection | DOAJ |
| description | The retrospective study enrolled 8 patients with ANCA-associated systemic vasculitis (AASV) and hip joint (HJ) injury with indications for total hip arthroplasty (HA); a total of 11 HJs were operated on. The patients’ median age at the time of the first HA was 54 [31; 76] years. The median duration of follow-up after HA was 3 [0.5 to 12.5] years. Wegener’s granulomatosis was diagnosed in 5 patients; microscopic polyangiitis in 2 patients, and eosinophilic granulomatosis polyangiitis (or Churg-Strauss syndrome) in one case. At the onset of AASV, the median Birmingham Vasculitis Activity Score (BVAS) was 12 [6; 26]; four patients had a 5-year mortality rate of 21% (Five-Factor Score (FFS) = 1). AASV remission was induced by anti-B cell therapy with rituximab (RTM) in 6 patients. A total of 10 total HAs were performed for aseptic necrosis of the femoral head and another HA was carried out for a femoral neck fracture. At the time of HA, complete remission (BVAS = 0) was observed in 7 cases of AASV; incomplete remission (BVAS = 3) was seen in one patient. All endoprosthesis components were stable; there were no signs of osteolysis. In all cases, HA was successful in increasing HJ functional activity and in reducing pain (the Harris hip score averaged 54 before HA and 87 at 6 months after surgery). None of the patients had AASV recurrence or developed postoperative complications (except for the need for blood transfusion).The authors’ own experience suggests that total HA is a potentially highly effective and relatively safe treatment in patients with AASV, including those with severe AASV and unfavorable prognostic factors. To reduce the risk of postoperative complications (primarily thromboembolism, infections, and RTM-induced late-onset neutropenia), total HA should be performed in the period of AASV remission under the control of comorbid conditions and in the close cooperation of rheumatologists and orthopedic surgeons. The following recommendations for the management of patients with rheumatic diseases should include patients with AASV for elective total HA. |
| first_indexed | 2024-04-09T22:23:07Z |
| format | Article |
| id | doaj.art-8d1e41d0479045139f8f8b6a3885e0a8 |
| institution | Directory Open Access Journal |
| issn | 1995-4484 1995-4492 |
| language | Russian |
| last_indexed | 2024-04-09T22:23:07Z |
| publishDate | 2019-11-01 |
| publisher | IMA PRESS LLC |
| record_format | Article |
| series | Научно-практическая ревматология |
| spelling | doaj.art-8d1e41d0479045139f8f8b6a3885e0a82023-03-22T13:45:55ZrusIMA PRESS LLCНаучно-практическая ревматология1995-44841995-44922019-11-0157559760310.14412/1995-4484-2019-597-6032536Successful total hip arthroplasty in patients with anca-associated systemic vasculitisT. V. Beketova0E. A. Naryshkin1E. V. Arsenyev2M. A. Makarov3V.A. Nasonova Research Institute of RheumatologyV.A. Nasonova Research Institute of RheumatologyV.A. Nasonova Research Institute of RheumatologyV.A. Nasonova Research Institute of RheumatologyThe retrospective study enrolled 8 patients with ANCA-associated systemic vasculitis (AASV) and hip joint (HJ) injury with indications for total hip arthroplasty (HA); a total of 11 HJs were operated on. The patients’ median age at the time of the first HA was 54 [31; 76] years. The median duration of follow-up after HA was 3 [0.5 to 12.5] years. Wegener’s granulomatosis was diagnosed in 5 patients; microscopic polyangiitis in 2 patients, and eosinophilic granulomatosis polyangiitis (or Churg-Strauss syndrome) in one case. At the onset of AASV, the median Birmingham Vasculitis Activity Score (BVAS) was 12 [6; 26]; four patients had a 5-year mortality rate of 21% (Five-Factor Score (FFS) = 1). AASV remission was induced by anti-B cell therapy with rituximab (RTM) in 6 patients. A total of 10 total HAs were performed for aseptic necrosis of the femoral head and another HA was carried out for a femoral neck fracture. At the time of HA, complete remission (BVAS = 0) was observed in 7 cases of AASV; incomplete remission (BVAS = 3) was seen in one patient. All endoprosthesis components were stable; there were no signs of osteolysis. In all cases, HA was successful in increasing HJ functional activity and in reducing pain (the Harris hip score averaged 54 before HA and 87 at 6 months after surgery). None of the patients had AASV recurrence or developed postoperative complications (except for the need for blood transfusion).The authors’ own experience suggests that total HA is a potentially highly effective and relatively safe treatment in patients with AASV, including those with severe AASV and unfavorable prognostic factors. To reduce the risk of postoperative complications (primarily thromboembolism, infections, and RTM-induced late-onset neutropenia), total HA should be performed in the period of AASV remission under the control of comorbid conditions and in the close cooperation of rheumatologists and orthopedic surgeons. The following recommendations for the management of patients with rheumatic diseases should include patients with AASV for elective total HA.https://rsp.mediar-press.net/rsp/article/view/2784total hip arthroplastyaseptic necrosisrituximabantineutrophil cytoplasmic antibody-associated systemic vasculitiswegener’s granulomatosismicroscopic polyangiitiseosinophilic granulomatosis polyangiitis (or churgstrauss syndrome) |
| spellingShingle | T. V. Beketova E. A. Naryshkin E. V. Arsenyev M. A. Makarov Successful total hip arthroplasty in patients with anca-associated systemic vasculitis Научно-практическая ревматология total hip arthroplasty aseptic necrosis rituximab antineutrophil cytoplasmic antibody-associated systemic vasculitis wegener’s granulomatosis microscopic polyangiitis eosinophilic granulomatosis polyangiitis (or churgstrauss syndrome) |
| title | Successful total hip arthroplasty in patients with anca-associated systemic vasculitis |
| title_full | Successful total hip arthroplasty in patients with anca-associated systemic vasculitis |
| title_fullStr | Successful total hip arthroplasty in patients with anca-associated systemic vasculitis |
| title_full_unstemmed | Successful total hip arthroplasty in patients with anca-associated systemic vasculitis |
| title_short | Successful total hip arthroplasty in patients with anca-associated systemic vasculitis |
| title_sort | successful total hip arthroplasty in patients with anca associated systemic vasculitis |
| topic | total hip arthroplasty aseptic necrosis rituximab antineutrophil cytoplasmic antibody-associated systemic vasculitis wegener’s granulomatosis microscopic polyangiitis eosinophilic granulomatosis polyangiitis (or churgstrauss syndrome) |
| url | https://rsp.mediar-press.net/rsp/article/view/2784 |
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