Objectives We evaluated the postoperative morbidity in patients with severe ANCA- associated vasculitis (AAV) undergoing primary total hip arthroplasty (THA).
Methods Retrospective analysis of interventional case series, single referral center study. Four patients with severe AAV due to destructive hip damage (5 affected hips) were selected for 5 THA.
Results The mean age of our cohort was 45 years (27- 66 years), 75% female. Two patients had microscopic polyangiitis (MPA), 1- granulomatosis with polyangiitis (GPA) and 1- eosinophilic granulomatosis with polyangiitis (EGPA). All patients had severe AAV and Five-Factor Score (FFS)=1. Short course of hemodialysis was required in one patient with MPA and rapidly progressive glomerulonephritis. In another case was the age of MPA onset >65 years. The GPA patient had a history of nephrectomy for hydronephrosis, which complicated afterwards with kidney and ureter granulomatous vasculitis and occlusive thrombosis of the femoral veins in the active phase of the disease. EGPA patient was overweight (BMI 28) and had EGPA-associated cardiomyopathy. Destructive hip damage was caused by osteonecrosis in 3 patients, and fracture of the proximal femur in 1 patient with osteoporosis. At the time of THA procedure all patients were in remission phase (BVAS=0) with normal serum creatinine levels, all comorbidities were controlled by medications. In two cases AAV remission was induced by rituximab.
All implants were radiographically stable without osteolysis. In all cases THA has been clinically effective, with functional gain such as improved mobility as well as pain reduction and was not associated with postoperative serious complications (except for blood transfusion requirements) or AAV relapse.
Conclusions Elective THA is a safe and effective procedure for destructive hip damage in the AAV patients, including cases with the history of severe vasculitis and unfavorable prognostic factors (FFS=1). AAV remission must be achieved and comorbidities identified and treated to minimize postoperative complications.
Disclosure of Interest None declared
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