Six-Year Follow-Up of Multiple Joint Replacement Surgery to the Lower Limbs

Abstract

We report a 6-yr follow-up study of an original population of 50 patients who had three or more major joints (hips and knees) replaced. Thirty-one of 32 surviving patients were still ambulant in the community, and all patients described significant pain relief. No RA patient was requiring permanent inpatient or residential care and the family remained the main social support. They remained a very disabled group with a median Health Assessment Questionnaire score of 2.75. Ten required revision surgery: three hips and seven knees; four patients required their fourth lower limb joint (hip/knee) replaced and seven patients required surgery to the upper limbs and nine feet during the follow-up period. The median 10-yr survival of hip and knee arthroplasties in multiple joint replacement (MJR) patients with RA was 90.5 and 78.6% respectively. There was an increased incidence of cervical myelopathy in MJR patients 16.9%. The mortality rate was higher than expected (standardized mortality ratio = 590) but the actual surgery was not implicated. MJR therefore appears to be a worthwhile policy, even at long-term follow-up.

Outcomes for patients undergoing one or more total hip and knee arthroplasties

“…The primary goal in performing TKA and/or THA in patients with advanced RA is to relieve pain and improve function in the lower extremities [3,4,[9][10][11].…”

“…Total hip (THA) and total knee (TKA) arthroplasties have been accepted as a standard treatment for joint destruction in patients with rheumatoid arthritis (RA) [1][2][3][4][5][6]. Patients with progressive RA frequently undergo multiple arthroplasties in the lower extremities.…”

“…Patients with progressive RA frequently undergo multiple arthroplasties in the lower extremities. However, few studies showing the quality of life (QOL) and mortality outcomes after the arthroplasties have been reported [1][2][3]. This study evaluated the long-term outcomes of overall pain, ambulation, disability and mortality in RA patients with unilateral, bilateral, triple and quadruple joint arthroplasties.…”

Results of a single total knee prosthesis compared with multiple joint replacement in the lower limb

“…Marks [9] reported that only 59% of 21 rheumatoid patients with multiple replacements were pain-free. Walker et al [15] in a series of 36 patients with 3 or more joints replaced and a mean follow-up of 20 months recorded that 49% of patients had only moderate or slight improvement of pain and McDonagh et al [10] reported further on this group indicating that 7 knees required revision after a mean of 3 years. Hoekstra et al [3] reported on 14 rheumatoid patients with 4 joint replacements and a mean follow-up of 71 months with pain relief in all patients and no loosening.…”

“…However, most of these studies have been restricted to rheumatoid patients using a prosthesis which was either constrained or unconstrained. Although these results were encouraging a number of patients continued to complain of pain and revision rates as high as 19% within 5 years have been reported [10]. The aim of this study was to investigate possible differences in the outcome after an isolated Total Knee Replacement (TKR) compared with patients who underwent multiple hip and knee replacement.…”