Total knee arthroplasty in young patients with rheumatoid arthritis
Abstract
Background: The main purpose of this study was to evaluate the outcomes of total knee arthroplasty in patients <55 years with rheumatoid arthritis analyzing the distinctive features of this group (range of motion, pain, prosthesis survival).Methods: Twenty four total knee arthroplasties in 14 patients (12 women) were evaluated. Average age: 47.4 years, with a follow-up of 5.8 years. Four were unilateral replacements and ten were bilateral. Twenty foreign design implants and 4 national ones were used. One patient (4.16%) required a metallic wedge and two (8.3%) needed femoral and tibial stems.Results: Before surgery 14 knees presented extension deficit and average range of motion was of 92.8°. The preoperative femorotibial angle was valgus in 22 knees with an average of 12° and 2 varus with average of 3°. Postoperative range of motion at 6 weeks was an average of 90º and 110º at first years, in all patients. Knee Society clinical and functional score improved from an average of 42 to 83, and from 42 to 89, respectively. There were 2 complications: an extensor mechanism rupture that was resutured, developing a synovial fistula that required 3 toilettes, with favorable outcome and one mechanical loosening that required revision.Conclusions: At the expense of pain relief and functional improvement, total knee arthroplasty in young patients with rheumatoid arthritis seems a procedure with very good medium term outcomes. Preoperative planning, taking into account the possibility of using stem and metal supplements, is necessary.Downloads
References
Chandler HP, Reinick T, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old. J Bone
Joint Surg Am 1981;63:1426-34.
Door LD, Luckett M, Conaty JP. Total hip arthroplasty in patients less than forty-five years old. Clin Orthop 1990;260:215-9.
Lonner JH, Hershman BA, Mont M, Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with
osteoarthritis. Clin Orthop Relat Res 2000;380:85-90.
Dalury DF, Ewald FC, Christie MJ, Scott RD. Total knee arthroplasty in a group of patients less than 45 years of age.
J Arthroplasty 1995;10:598-602.
Duffy GP, Trousdale RT, Stuart MJ. Total knee arthroplasty in patients 55 years old or younger: 10 to 17 years result. Clin
Orthop 1998;356:22-7.
Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than 55 years. Clin Orthop 1989;248:27-33.
Diduch DR, Insall JN, Scott WN, Scuderi GR, Rodriguez FD. Total knee arthroplasty in young, active patients. Long term
follow-up and functional outcome. J Bone Joint Surg Am 1997;79:575-82.
Garabano y cols. Rev Asoc Argent Ortop Traumatol
Wainwright C, Theis JC, Melloh M. Age at hip or knee joint replacement surgery predicts likelihood of revision surgery. J
Bone Joint Surg Br 2011;93(10):1411-5.
Ebert FR, Krackow KA, Hungerford DS. Minimum 4 years follow-up of PFC total knee arthroplasty in rheumatoide patients.
J Arthroplasty 1992;7:101-6.
Rodriguez JA, Saddler S, Ranawat CS. Long term results of total knee arthroplasty in class 3 and 4 rheumatoid arthritis. J
Arthroplasty 1996;11:141-6.
Lopreite FA, Garabano G, Mana PD, del Sel H. Artroplastia total de rodilla en pacientes con artritis reumatoide. Rev Asoc
Argent Ortop Traumatol 2010;75:2:171-6.
Kristensen O, Nafei A, Kjaersgaars-Andersen P, Jensen J. Long term results of total condilar knee arthroplasty in rheumatoid
arthritis. J Bone Joint Surg Br 1992;74:803-6.
Stuart MJ, Rand JA. Total knee arthroplasty in young adults who have rheumatoid arthritis. J Bone Joint Surg 1988;70:84-7.
Gill GS, Chan KC, Mills DM. 5 to 18 years follow up study of cemented total knee arthroplasty for patients 55 years old or
younger. J Arthroplasty 1997;12:49-53.
Bhan S, Malhotra R, Eachemati KK. Total knee arthroplasty without patellar resurfacing in patients with rheumatoid arthritis.
Clin Orthop 2006;450:157-63.
Yang JP, Bogoch ER, Hearn TC. Stiffness of trabecular bone of the tibial plateau in patients with rheumatoid arthritis of the
knee. J Arthroplasty 1997;12:798-803.
Hofmann AA, Heinhoff SM, Camargo M. Cementless total knee arthroplasty in patients 50 years or younger. Clin Orthop
;404:102-7.
Meding JB, Keating EM, Ritter MA, Faris PM, Merill A, Berend ME. Long-term follow-up of posterior cruciate-retaining
TKR in patients with rheumatoid arthritis. Clin Orthop Relat Res 2004;428:146-52.
Crowder AR, Duffy GP, Trousdale RT. Long-term results of TKA in young patients with rheumatoid arthritis. J Arthroplasty
;20(Suppl 3):12-5
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