Total Knee Arthroplasty in Rheumatoid Arthritis

Lee, Jin Kyu; Choi, Choong-Hyeok

doi:10.5792/ksrr.2012.24.1.1

Cited by 74 publications

(78 citation statements)

References 28 publications

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“…1,4 In addition, patients with RA usually undergo joint replacement surgery at a younger age than patients with osteoarthritis. 3,20 Therefore, women with RA are more likely to reach menopause after joint replacement, and this may be a reason for the sudden increased incidence of periprosthetic fracture within 10 years of TKR.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

“…[1][2][3] Performing TKR in patients with RA can be technically difficult owing to the poor quality of bone and surrounding soft tissues and to associated bone deformities. 3,4 Long-term results of TKR for rheumatoid knees have been well documented, with a reported survival rate of the prosthesis between 81% and 97.7% at more than 10 years of follow-up. [5][6][7][8][9] However, there is controversy about whether to retain or excise the posterior cruciate ligament (PCL) in rheumatoid knees because attenuation of the ligament is often present in this subgroup of patients.…”

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

et al. 2015

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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...

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Section: Discussionmentioning

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

et al. 2015

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“…Although newer biological agents have been developed to decrease synovitis and prevent joint destruction in those who have early disease, many patients ultimately end up with late-stage disease. The knee makes up 27 % of all joints affected [2], and total knee arthroplasties (TKA) are highly successful procedures for advanced knee rheumatoid arthritis as they markedly enhance functionality and overall quality of life [3]. However, because of the complex systemic nature of this disease, practitioners need to give special consideration to potential adverse events and complications in this population group undergoing TKA [4].…”

Section: Introductionmentioning

confidence: 99%

Thirty-day complications in rheumatoid patients following total knee arthroplasty

et al. 2015

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Although total knee arthroplasty (TKA) is highly successful for patients with end-stage rheumatoid arthritis (RA), the risks and complications associated with surgery in this cohort are less defined. The objectives of our study were to analyze the demographic and perioperative factors of RA patients that may affect post-TKA outcomes, as well as to assess the 30-day complication rates compared to osteoarthritis patients. We retrospectively evaluated the National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2012 to assess all patients who underwent a primary TKA and had a diagnosis of rheumatoid arthritis (n = 141) or primary knee osteoarthritis (n = 7125). We evaluated and compared the demographic factors, social factors, preoperative factors, operative factors, and postoperative complications. The RA cohort had a lower mean age and body mass index than patients in the OA group. There was also a significantly higher incidence of women and Hispanics in the RA cohort. There was a lower incidence of diabetes and hypertension requiring medication in the rheumatoid cohort, but also a higher incidence of bleeding disorders. The RA cohort had an increased proportion of patients requiring blood transfusions and had a longer mean length of stay. The incidence of pneumonia and postoperative bleeding that required transfusion was also higher in RA patients. Rheumatoid patients had higher rates of wound infections, pulmonary embolisms, and deep vein thrombosis; however, these findings were not significant. Although RA patients with end-stage knee arthritis may benefit from TKA, these patients should be preoperatively optimized to minimize complication risks.

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“…2 In the absence of a bleeding disorder, the most common underlying pathology for recurrent haemarthrosis is impingement of the proliferative synovium. 3 A thorough history and examination together with relevant radiological and laboratory investigations will identify most of the causes.…”

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confidence: 99%

The Role of Synovectomy in Total Knee Arthroplasty: A Prospective Analysis of 30 Cases

M¹,

Chandan²,

Shanker³

et al. 2016

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AIM AND OBJECTIVESAim and objective of this study is to assess role of synovectomy during TKR on joint effusion, haemarthrosis, patellar clunk, recurrent synovitis, and histopathological diagnosis in patients undergoing Total Knee Arthroplasty (TKA). MATERIAL AND METHODSWe studied prospectively 30 patients with osteoarthritis of knee treated with total knee arthroplasty with near-total synovectomy. Patients were in the age group 55-70 years. The overall efficacy of both procedures was assessed postoperatively by determination of blood loss from the drain, pain, and Lysholm knee functional score. RESULTSAll 30 patients have been followed up for an average of 3 years for assessment for postoperative pain, knee joint effusion, patellar clunk, range of movement, and stability of prosthesis. During the postoperative 48 hours, the mean blood loss was slightly higher. To conclude, supplementing near-total synovectomy along with TKA may provide complete pathological diagnosis, beneficial in inflammatory arthritis, and some special synovial pathology like pigmented villonodular synovitis, rheumatoid arthritis, tuberculous arthritis, and haemophilic arthritis. Better long-term pain relief and functional outcome due to the removal of pathological synovium have been observed after synovectomy along with total knee arthroplasty. CONCLUSIONPerforming synovectomy in TKA will give complete pathological diagnosis, avoiding persistence of synovial pathology along with long-term benefits of synovectomy in the form of minimal to no joint effusion, less pain, absence of synovial hypertrophy, patellar clunk, and good range of movement of knee.

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Total Knee Arthroplasty in Rheumatoid Arthritis

Cited by 74 publications

References 28 publications

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

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

Thirty-day complications in rheumatoid patients following total knee arthroplasty

The Role of Synovectomy in Total Knee Arthroplasty: A Prospective Analysis of 30 Cases

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