Rheumatology grand rounds loosening of a revision total hip replacement in a 60-year-old woman with longstanding rheumatoid arthritis clinicopathologic conference
✍ Scribed by Ellen M. Gravallese; Barbara N. Weissman; Gilbert Brodsky; James Maguire; Don L. Goldenberg
- Publisher
- John Wiley and Sons
- Year
- 1995
- Tongue
- English
- Weight
- 971 KB
- Volume
- 38
- Category
- Article
- ISSN
- 0004-3591
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✦ Synopsis
A 60-year-old woman with a 30-year history of deforming, rheumatoid factor-positive rheumatoid arthritis (RA) presented with a 1-year history of pain in the right groin. For the 3 years prior to admission, she had been treated with oral methotrexate, 7.5 mg/week, and prednisone, 7 mg/day. Previous medical therapy for RA included nonsteroidal antiinflammatory drugs (NSAIDs), diseasemodifying antirheumatic drugs (DMARDs; hydroxychloroquine sulfate, sulfasalazine, gold sodium thiomalate, and penicillamine), and multiple courses of steroids in low dosage. She had undergone multiple surgical procedures of her joints, including a right total hip replacement (THR) 20 years previously, with a cemented cobalt-chrome femoral prosthesis and an ultra high molecular weight (UHMW) polyethylene acetabular component. Seven years prior to admission, she underwent a revision surgery because of loosening of the acetabular component. A porous-ingrowth metal shell with a UHMW polyethylene liner was used. Pathologic specimens from the revision hip surgery revealed synovial tissue with fibrotic changes and a histiocytic infiltrate.