Long-term results of cruciate-retaining total knee replacement in patients with rheumatoid arthritis: a minimum 15-year review

Abstract

Background:There is controversy about whether to retain or excise the posterior cruciate ligament in rheumatoid knees because attenuation of the ligament is often present in this subgroup of patients. We reviewed more than 15 years of results of cruciate-retaining total knee replacements (TKRs) in patients with rheumatoid arthritis. Methods:We reviewed patients' charts and radiographs to evaluate knee range of motion and flexion contractures, component loosening and osteolysis at the bonecement interface. Our primary outcome was revision of a femoral or tibial component for any reason, and the secondary outcome was revision for any reason and periprosthetic fracture during the follow-up period.Results: Our study included 112 patients (7 men, 105 women, 176 knees). Their mean age was 49.3 (range 33-64) years. Twenty-one patients died and 16 were lost to followup, leaving 75 patients (119 knees) with a minimum follow-up of 15 (mean 16.1) years for our analysis. Of these, 61 patients (101 knees) were available for clinical and radiological evaluation at the final follow-up assessment. At a mean of 12.2 (range 6-16) years, revision was necessary in 14 patients (19 knees), including 1 patient with an infection. Eleven patients (11 knees) had periprosthetic fractures at a mean of 11.4 (range 5-14) years after the index operation. The survival rate, with the end point being revision of the femoral or tibial component for any reason, was 98.7% at 10 years and 83.6% at 17 years. The survival rate of revision and periprosthetic fracture was 97.6% at 10 years and 76.9% at 17 years. Conclusion:Special attention should be paid to component loosening or periprosthetic fracture after more than 10 years of follow-up in this subgroup of patients. Contexte :On ne s'entend pas sur la nécessité de conserver ou d'exciser le ligament croisé postérieur dans les genoux rhumatoïdes en raison de l'affaiblissement du ligament, souvent présent chez cette catégorie de patients. Nous avons passé en revue sur plus de 15 ans les résultats de prothèses totales du genou (PTG) avec préservation du ligament croisé chez des patients atteints de polyarthrite rhumatoïde.Méthodes : Nous avons examiné les dossiers et les radiographies des patients pour évaluer l'amplitude de mouvement et les contractures en flexion des genoux, le descellement des composants et l'ostéolyse à l'interface os-ciment. Notre paramètre principal était la révision d'un composant fémoral ou tibial, peu importe la raison, et le paramètre secondaire était la révision, peu importe la raison, ainsi que les fractures périprothé-tiques durant la période de suivi.Résultats : Notre étude a regroupé 112 patients (7 hommes, 105 femmes; 176 genoux). L'âge moyen était de 49,3 ans (entre 33 et 64 ans). Vingt-et-un patients sont décédés et 16 ont été perdus au suivi, ce qui laissait 75 patients (119 genoux) et un suivi minimum de 15 ans (moyenne 16,1 ans) pour notre analyse. Parmi ces patients, 61 (101 genoux) étaient disponibles pour évaluation clinique et radiologique à la dernière évaluat...

Rates and outcomes of total knee replacement for rheumatoid arthritis compared to osteoarthritis

“…Improvements in RA medical therapy have markedly reduced the severity of symptoms in many, but RA patients continue to have a disproportionate need for surgery including arthroplasty surgery . Total knee replacement (TKR) is a frequent and efficacious treatment for RA patients with severe disease, designed to relieve joint pain whilst correcting deformity and enhancing mobility . The reported 10‐year survivorship of TKR in RA patients has a range of 81–97.7% …”

“…The current literature remains controversial with regards to prosthetic constraint that should be used for RA patients undergoing TKR. Many studies recommend the use of a cruciate substituting design while others have shown excellent results with cruciate retaining designs …”

Evaluating Posterior Cruciate Ligament Integrity in Inflammatory Arthritis Patients Prescribed Biologic Agents: A Radiological Case-Control Study

“…The authors concluded that posterior instability due to PCL insufficiency is rarely the cause for revision in these patients [ 6 ]. Lee et al demonstrated excellent long-term survivorship at a minimum of 15-year follow-up with CR designs in RA patients and found no cases of revision resulting from PCL insufficiency [ 12 ].…”

Rationale of Cruciate Retaining Design in Rheumatoid Arthritis: A Review of Clinical Analysis and its Role in Rheumatoid Arthritis

“…This change is noted in several studies across the globe, a 25 year follow up study from Mayo clinic demonstrated a good functional outcome score (mean score 79) at the end of 25 years [ 6 , 7 ]; a minimum 15 year follow up study from Korea noted an excellent post-operative functional score of 80 at final follow up [ 8 ]; a 12 year follow up study from Japan shows a good mean functional outcome score of 70 at final follow up [ 9 ]. These findings further reiterate the favourable long term functional status of cruciate retaining prosthesis.…”

“…Cruciate retaining design is a less constrained prosthesis which allows better controlled femoral roll back than posterior stabilised design. Among the available literature Table 1 , the maximum average range of motion of 115 o was noted in a 22 year follow up study by Lee et al and correlates with the average knee ROM after TKA in OA patients [ 8 ]. The longest follow up study till date from Mayo clinic demonstrates an average knee ROM of 100 o [ 6 , 7 ].…”