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ObjectivesWe evaluated the postoperative morbidity in patients with severe ANCA- associated vasculitis (AAV) undergoing primary total hip arthroplasty (THA).MethodsRetrospective 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.ResultsThe 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.ConclusionsElective 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 InterestNone declared

Objectives to evaluate effectiveness, the clinical outcomes and quality of life before and after total elbow arthroplasty using semiconstrained prostheses Coonrad-Morrey in patients with rheumatoid elbow. Methods Total elbow arthroplasty of 19 elbow was performed on in 18 patients with RA with radiographic changes of Larsen grade 5 or 6 (osteolytic destruction or ankylosis elbow). Patients had severe pain and instability, or absense of moution. We evaluated range of motion and pain. The Mayo Elbow Performance Score and Oxford Elbow Score was used to assess total elbow function; EQ-5D, HAQ – for evaluation quality of life. Results The average age of patients was 44,4±14,61 years (20 to 72 years) and there was a 16 female and 2 male (8:1). There were 66,7% seropositive patients. The mean of follow up was 18.5±5,2 months (ranging from 6 months to 3 years). The average duration of RA was 15,0±6,06 years. The average duration elbow complains 8?88±5,23 years. There were pain in 100% patients, synovitis and contrarture of elbow joint. The average increase in flexion was from 102,77±19,75° preoperatively to 116,67°±9,62° and extension was from 51,66±37,04° preoperatively to 24,33°±12,81° at short term follow up (p< 0.05). The average increase in Mayo Elbow Score 37,77/82,2 and Oxford Elbow Score 20,44/39,3 on long term follow up (p < 0.05). The mean EQ-5D (index) score improved from 0,36 to 0,72, HAQ from 1,67 to 1,22; VAS from 48 to 22. There was no neurovascular complication and infection, but in 6 cases (28,57%) were recurrent synovitis. Complications included 2 cases loosening of ulnar component, two cases of ulnar nerve palsy/neurapraxia and 2 cases elbow stiffnes. Conclusions Good function can be achieved in the short term with the Coonrad-Morrey-semiconstrained total elbow replacement prosthesis in patients with RA with severe elbow destruction References rheumatoid arthritis, elbow arthroplasty Disclosure of Interest None Declared

Background In cases refractory to conservative treatment chronic knee synovitis, surgical procedures are recommended. The role of arthroscopic synovectomy in improvement quality of life and knee function is still in discussion. Objectives To assess the results of arthroscopic synovectomy (AS) and its influence on Quality-of-Life Index (QLI) of the patients with rheumatoid arthritis (RA) in treatment of chronic knee synovitis. Methods Since 2003 and up till 2011 in the orthopaedic department of Institute of Rheumatology were performed 120 AS of the knee jointfor 105 patients with RA. Average follow-up period-4,1±2,03 years, mean age-41,1±14,4 years. In history of all patients during the treatment with basic anti-inflammatory drugs, oral and intraarticular administration of glucocorticoids (GC), there has been a stable chronic knee synovitis for more than three months. Patients were evaluated by: EQ-5D questionnaire analysis, HAQ functional assessment, Knee Society Score (KSS) functional check. The effect of AS on pain relief was measured by Visual analogue scale (VAS) for pain before and after the surgery. Results Analysis of the drug therapy has shown that during the first years of illness 12,5% of the patients received sulfasalazine (2 g daily), however the treatment was not lengthy (1,8±1,6 years). 80,4% of the patients received methotrexate (MT) in small doses (7,5-10 mg weekly) and inconstantly (usually the treatment was stopped by the patients themselves), the duration of its continuous intake was around 2,3±2,5 years. Leflunomide (LF) dose of 20 mg daily was administered in cases of intolerance or inefficiency of MT for 19,2% of the patients. 36,7% received GC orally. In history of 100% of the patients were ineffective intraarticular injections of GC for more than 3 months. Our study showed, that AS successfully alleviated the synovitis symptoms, improved knee function and QLI: HAQ index before surgery was 1,33±0,88, and after 0,75±0,72 (p<0,05). A positive dynamics was also recorded for EQ-5D index:0,39[-0,24-1,0] vs 0,64[0,06-1,0](before and after surgery respectively, p<0,05). VAS for pain: 50,2±26,89 vs 21,7±21,98 (before and after surgery respectively, p<0,05). KSS functionality of the treated knee has improved: 39±18,5 vs 74,1±28,9 (before and after the surgery respectively); as for analyzing the condition of the knee joint the average results were 48,3±18,7 vs 69,1±26,9 (before and after the surgery respectively, p<0,05). Range of motion increased up to the score of 22,8±3,2 (114° ±16 °) in comparison to 20,4±2,3before the surgery (102°±11,5°, p<0,05). 3,3% of the patients had a second AS, 4,2% required total arthroplasty of the knee joint. Conclusions The results above demonstrate that AS is an effective method of treatment of chronic knee synovitis in cases of RA which can not only improve the knee function but also raise QLI of the patients. Disclosure of Interest None Declared

Objectives to evaluate effectiveness, the clinical outcomes and quality of life before and after arthroscopic synovectomy in patients with rheumatoid arthritis Methods Arthroscopic synovectomy of elbow was performed on in 21 patients with RA with radiographic changes of Larsen grade 3 or less. All patients had severe pain and swelling, resulting from acute or chronic synovitis, that had not responded to conservative treatment during 6 months. We performed total synovectomy of the elbow using multiple portals. Pain was evaluated with a visual analog scale and range of motion was measured. The Mayo Elbow Performance Score and Oxford Elbow Score was used to assess total elbow function; EQ-5D, HAQ – for evaluation quality of life Results The average age of patients was 40,5±13,25 years (18 to 57 years) and there was a 11 female and 10 male (1,1:1). There were 50% seropositive patients. The mean of follow up was 12.5±5,2 months (ranging from 7 to 22). The average duration of RA was 7,87±6,37 years. The average duration elbow complains 2,25±1,62 years. There were pain in 100% patients, synovitis and contrarture of elbow joint. The average increase in flexion was from 114,4° preoperatively to 127,5° at long term follow up and extension was from 27,5° preoperatively to 2,3° (p< 0.05). The average increase in Mayo Elbow Score 48,75/93,12 and Oxford Elbow Score 18,5/8,87 on long term follow up (p < 0.05). The mean EQ-5D (index) score improved from 0.23 to 0.72, HAQ from 1,59 to 0,84; VAS from 61,25 to 8,75. There was no neurovascular complication and infection, but in 6 cases (28,57%) were recurrent synovitis Conclusions Arthroscopic synovectomy of the elbow effectively relieve pain, increase range of motion and quality of life, improve Mayo and Oxford Elbow Score, although recurrent synovitis occurs in some patients References rheumatoid arthritis, arthroscopic synovectomy, elbow Disclosure of Interest None Declared