The endoprosthesis as hope for rheumatism patients
Back to mobility and quality of life
Photo: Jelena Stanojkovic | shutterstock.com
Chronic joint pain, restricted movement, and exhaustion—rheumatic diseases are often chronic conditions that occur in episodes, with symptoms becoming increasingly severe. In an interview with Hellersen Insight, Bernd Irlenbusch, Senior Consultant in Endoprosthetics, talks about the particular challenges and risks involved in treating rheumatism patients with artificial joints and explains how technological advances in endoprosthetics have significantly improved surgical treatment options.
What role do endoprostheses play in the treatment of patients with advanced rheumatism?
Bernd Irlenbusch: Similar to osteoarthritis patients, the role of endoprostheses in rheumatism is clear: to prevent disability and immobility. Artificial joint replacement, especially in the hip and knee, restores mobility and prevents rheumatism patients from becoming dependent on care.
“Artificial joint replacement, especially in the hip and knee, restores mobility and prevents rheumatism sufferers from becoming disabled and dependent on care.”
Bernd Irlenbusch
Senior Consultant in Endoprosthetics
Are there certain “subtypes” of rheumatism or disease progression that require earlier or later intervention with endoprostheses?
Bernd Irlenbusch: Rheumatology, like orthopedics or neurology, is a separate field with numerous diseases that are classified into different categories. More than 100 different rheumatic diseases are known, each of which must be specifically differentiated and treated individually. These include, for example, rheumatoid arthritis in adults, psoriatic arthritis, and juvenile arthritis in children. If left untreated with medication, the first two can quickly lead to joint destruction and thus to a corresponding loss of function, immobility, and disability. The group of juvenile rheumatic diseases that affect children and adolescents often show such advanced joint damage by the age of 20 or 30 if they do not respond to drug therapy that only surgical treatment is possible. In general, it can be said that rheumatism patients require artificial joint replacement about 10 years earlier than osteoarthritis patients.
X-ray images of a 40-year-old female patient with rheumatoid arthritis inadequately controlled by medication: While the X-ray image shows a closed joint space on the outside, the MRI reveals a pronounced bone defect (rheumatoid cyst) on the outer head of the tibia. These bone erosions are typical of severely inflamed rheumatoid joints. In this case, an endoprosthesis was necessary to preserve the joint.
X-rays of a 70-year-old female patient with long-standing chronic arthritis: The pronounced bowlegs with a 30° varus deformity indicate advanced joint destruction. Correction and straightening were only possible with the use of a coupled hinge prosthesis. (Before and after comparison).
What progress has been made in endoprosthesis technology to better meet the needs of patients with rheumatism?
Bernd Irlenbusch: Advances in endoprosthetics have also greatly benefited rheumatism sufferers, as they offer two significant advantages. Firstly, we can fit patients with endoprostheses earlier, as improvements in replacement surgery mean that these operations can now be performed more frequently. In the 1980s, this was still a major problem: endoprostheses could often only be replaced once, and patients who needed a prosthesis at a young age, around 30 or 40, often had to wait until they were 60 to receive treatment. Modularity, i.e., the ability to adapt an implant to individual circumstances during surgery, enables us to treat rheumatism patients earlier and better, even in cases of bone defects.
On the other hand, in the 1980s and 1990s, implants were often fixed with bone cement in rheumatic patients, as they generally have very soft bones. This has changed today. Cementless endoprostheses represent an advance in that they are easier to replace. The two main advances are therefore modularity and improvements in cementless implants.
“Statistically speaking, the revision rate, i.e. the need for follow-up surgery for hip replacements, is 1.6 times higher in rheumatism patients than in non-rheumatism patients.”
Bernd Irlenbusch
Senior Consultant in Endoprosthetics
Photo: freepik.com
How do you assess the risk of endoprosthesis in patients with underlying rheumatoid disease compared to patients with other orthopedic conditions?
Bernd Irlenbusch: Statistically speaking, the revision rate, i.e. the need for follow-up surgery for hip replacements, is 1.6 times higher in rheumatism patients than in non-rheumatism patients. Particular attention should be paid to the infection rate, which is almost twice as high in rheumatism patients, at 1.8 times higher.
The increased susceptibility can be attributed to several factors. On the one hand, the immunosuppressive drugs that rheumatism sufferers often take play a role. These drugs deliberately weaken the immune system, but also lead to a higher susceptibility to infection. On the other hand, skin problems (psoriasis, cortisone skin) are an additional complication, which are associated with an increased risk of infection. Finally, rheumatism sufferers often have “softer” bones as a result of osteomalacia or osteoporosis, which makes it more difficult for the implant to anchor itself in the bone or heal properly.
As in other surgical fields, the complication rate decreases with the increasing experience of the surgeon. Rheumatism patients should therefore seek treatment at a center with surgeons who have expertise in rheumatic surgery.
