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HomeReview of the conditionConsidering surgeryWho should consider hip surgery for rheumatoid arthritis?What happens without surgery?Surgical options Effectiveness Urgency Risks Managing risk Preparing for surgeryAbout the procedureRecovering from surgeryRehabilitationConclusion

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Hip Surgery for Rheumatoid Arthritis.

Last updated Thursday, January 06, 2005

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Considering surgery

Who should consider hip surgery for rheumatoid arthritis?

RA patients who have unrelenting hip pain and destructive arthritis of their hip joint that does not respond favorably to medical management should consider total hip replacement. RA patients with hip involvement in early stages, who do not yet have destructive arthritis, yet have unexplained debilitating pain should consider hip arthroscopy.

What happens without surgery?

The best case scenario includes inactivity and decreased mobility in conjunction with antirheumatic medication and steroids can cause some improvement of symptoms.

A worst case scenario might be severe destruction of the hip joint and associated osteoporosis and reduced physical capacity potentially leading to a compromised hip replacement at a later stage with a less predictable outcome.

Surgical options

Total hip replacement is the treatment of choice for patient with rheumatoid arthritis with destroyed hip joints. Occasionally, hip arthroscopy is indicated in patients with early RA of the hip.

Effectiveness

More than 80% of patients will have a satisfactory result for 12-15 years after hip replacement surgery.

Urgency

Hip replacement surgery is an elective procedure and should be done only after non-surgical medical management has failed. Once indicated, postponing the surgery for an extended period of time (months or years) only leads to increased disability, disuse osteoporosis, and skeletal complications that can make surgery more difficult and potentially compromise the final result.

Risks

The most common risks of hip replacement surgery for RA are infection, dislocation of the hip joint, and mechanical failure due to loosening of metal components from the bone. Mechanical loosening occurs in approximately 13% over 12 years and is mostly due to loosening of the metal socket. Infections and dislocations occur in approximately 2% of patients. Infection and dislocation can cause early failure and might prohibit a good result.

Managing risk

These complications can necessitate a revision hip replacement. If an infection occurs then the prosthesis needs to be removed. A six week period of antibiotic treatment is needed and if the infection is cured a revision hip replacement can be done. If the hip dislocates, it needs to be relocated in the emergency room with sedation or in the operating room under anesthetic. Recurrent dislocations can lead to revision hip replacement surgery.

Surgery for rheumatoid arthritis of the hip at the University of Washington

If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.

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