Larsen III–V destruction with significant clinical symptoms. Progressive bone destruction, particularly in the acetabular area (acetabular roof necrosis, protrusion, cysts, etc.).
Principles for determining treatment
Treatment is initiated earlier in rheumatoid patients than in arthritis patients in order to avoid simultaneous progressive destruction in multiple joints (see also indications for knee prosthesis, Chapter 7.2).
Progressive bone destruction in a rapidly progressing course: do not wait until the acetabular fossa is destroyed. Regular radiographic monitoring is recommended because progression can be relatively asymptomatic compared with the overall level of disease.
Specific disclosures for patient consent
Prosthetic loosening; dislocation. Bone fracture; perforation.
Prosthesis set from the manufacturer of choice.
The position will be according to the chosen approach (anterior, anterolateral, dorsal, minimally invasive). The superiority of one approach over another has not been established in rheumatoid patients. It is therefore recommended to use the approach that one is most familiar with. The use of a special hip table is recommended.