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Bilateral total hip arthroplasty for secondary protrusive coxitis (clinical case)

The presence of combined joint contractures, the development of secondary protrusive coxarthritis (PC), severe osteoporosis and bone destruction in patients with rheumatoid arthritis (RA) and spondyloarthritis produce a number of technical difficulties during the implementation of total hip arthroplasty (THA). In this article we have presented a clinical case of bilateral cementless THA performed in a patient with RA and secondary PC. Before surgery the functional Harris score was 20 points, and the DA-S28 (disease activity score) was 3.1. The patient had PC of the third degree on the right and the second degree on the left side. During THA on the right side we applied the technique of impact bone autoplasty. Four years after surgery, the functional Harris score was 73; DAS‑28 was 2.7. Thus, the combination of conservative therapy and surgical treatment improves patient's clinical and functional state and also helps to maintain low activity of RA.