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Rheumatoid arthritis (RA) is a chronic systemic disease that causes progressive joint damage, bony defects, and ligament imbalance. These sequelae of RA present major difficulties to surgeons during hip or knee arthroplasty. The presence of coexistent periarticular fractures adds to these difficulties and represents a surgical dilemma. No guidance exists within the literature for the medical and surgical management of complicated cases of RA with coexistent fractures. So far, the evidence has focused on fixation techniques, arthroplasty, and conservative management for periarticular fractures of osteoarthritic joints without significant degeneration of anatomical structures. We report a case of advanced knee RA with associated ipsilateral tibial plateau fracture and a tibial shaft stress fracture that was treated successfully with a single-stage joint replacement procedure. The case study presents a well-planned, single-stage arthroplasty with a lateral parapatellar approach as a management option that allows for early weight-bearing and restoration of function and provides a detailed guide for surgeons when managing similar cases.

This study aims to determine the mean posterior condylar angle (PCA) in the included population and its relation to coronal alignment; and to know the clinical importance of the use of preoperative computed tomography (CT) scan in total knee arthroplasty (TKA). We randomized 50 patients with primary knee osteoarthritis into 2 groups. We used CT scan axial images to measure the PCA. In the first group we followed the CT scan plan (group 1), but in the second we did not follow the plan and adjusted rotation to the standard three degrees (group 2). The mean age of the included patients was 63 years. The radiological data of the included patients showed 5 patients with valgus deformity and 45 patients with varus deformity with the mean coronal alignment of 7.5 degrees. CT scan showed the mean PCA of 3.7 degrees (1.3 degrees). The axial knee postoperative X-ray showed the mean patellar tilt angle of 2.1 degrees (0.5 degrees) and 1.9 degrees (0.5 degrees) in groups 1 and 2, respectively. The congruence angle was 4 degrees (2.6 degrees) in group 1 and 5.5 degrees (3.2 degrees) in group 2. The median Knee Society functional score in group 1 was 85 (12), while it was 84 (7.5) in group 2. The median postoperative Western Ontario and McMaster Universities Arthritis Index score in group 1 was 84 (18.6) whereas 80.2 (13.6) in group 2. The median postoperative Bartlett score in group 1 was 30 (5), while it was 30 (6) in group 2. The use of preoperative CT scan did not improve the patient functional scores after TKA.

Background: Hip fractures are a common cause of morbidity, especially in the elderly. Treatment of extracapsular hip fractures is highly controversial. Fixation is the main treatment for this type of fracture including extramedullary and intramedullary fixation. The problem of fixation failure remains the main drawback. Many trials have shown that arthroplasty as an alternative option would have better functional results, especially in the early postoperative period. The aim of this review was to compare the functional outcomes of internal fixation versus arthroplasty in the treatment of intertrochanteric fractures. Methods: Two reviewers searched the following databases: PubMed, the Cochrane Library, Ovid, and Science Direct for randomized control trials (RCTs) and quasi-random trials comparing the outcomes of internal fixation and arthroplasty in the treatment of intertrochanteric fractures. We assessed the quality of the studies meeting the eligibility criteria by using the Cochrane assessment tool. For measuring the outcomes, we used the mean difference with 95% confidence interval for continuous data and risk difference, with 95% confidence interval for dichotomous data. Results: The electronic search revealed 3402 citations. After removing duplicate articles, 3397 citations were screened for possible inclusion in the review. Of those 3273 citations were excluded by title or abstract. One hundred and twenty-four full text articles were assessed for eligibility. Six studies compared the results of fixation versus arthroplasty. A meta-analysis of the studies showed no difference in mean Harris Hip Score between groups (mean difference −7.51 [−12.28, −2.74). There was also no difference in the independence of ambulation at 1 yr (risk difference 0.01 [−0.17, 0.19]). The cost of treatment was higher in the arthroplasty group (mean difference 5898.00 [5364.00, 6432.00]). There was no difference in reoperation (risk difference −0.09 [−0.15, −0.03]) and mortality risks (risk difference −0.10 [−0.32, 0.12]). Conclusions: Although most patients with intertrochanteric fracture are treated successfully with internal fixation, arthroplasty could be useful in certain types of fractures. However, there is a lack of high-quality evidence to assist surgeons in deciding when to use this option.