Total knee artroplasty in rheumatoid arthritis

Abstract

Rheumatoid arthritis eventually involves the knee in nearly 90% of patients with longstanding disease. Patients with severe knee involvement ojien have other joint involvement and are typically weakened by chronic disease. Although therapeutic medications and surgical treatment such as synovectomy may reduce symptoms, they of ten fail to prevent joint destruction. Thus, once significant articular desıı'uction has occured, total knee arthroplasty is the only treatment that oj/ers a significant probability for relief of pain and fimction.Forty-jive total knee arthroplasties were peıfOl'med in 28 patients with rheumatoid arthritis, between 1990 and 1996 at our department. One patient (two knees) died befOl'e the time of this study, 4 patients ( 7 knees) were lost to follow-up, Thus, 36 arthroplasties in 23 patients were available for review, There were 3 men (4 knees) and 20 women (32 knees) and their mean age was 50.8 (20-75) years. The mean follow-up period was 31.9 (6-72) months. Eleven of the patiens (48%) had multiple arthroplasties such as elbow, shoulder or hip arthroplasties. Patients were evaluated using the Knee Society rating scores. Knee score was 90.3 (78-100) and function score was 91.5 (55-100). No cases of radiologic loosening were observed.lncomplete radiolucent lines arol/nd the tibial components were detected in 4 knees. One patient developed Iate deep in( ection which reql/ired removal of the prosthesis. Two patients had reversible jibular paralysis. Flexion contraeture was present in 24 knees (66%) (average 16.6°; range 10°-50°) preoperatively, lt was present in two knees (5%) (/00 and 15°) postoperatively. Although our follow-up period is not vay long. Our short-term results are in accordance with the literature. Although there are major problems such as high infec·tion rate, multiple joint involvement, soji tissue problems in patients with rheumatoid arthritis, total knee arthroplasty appeares to be the only solution for relief of pain and function.

Keywords

• -

Romatoid artritli hastalarda total diz artroplastisi uygulamalarımız

Öz

Romatoid artritli hastalarda dizler hastalrğm ilerleyen yıllarında %90 gibi yüksek bir oranda tutulur. Bu dizlerde ağrının giderilmesi,fonksiyonların ve hareketliliğin kazanılması için en etkili yöntem total diz protezi uygulamalarıdır. çalrşmamızda 23 romatoid artritli hastanın 36 dizi değerlendirilmiştir. Hastalarımızm ortalama yaşları 50.8 yıl, takip süresi ise 31.9 ay olarak bulunmuştur. Knee Society klinik değerlendirme formuna göre diz skoru 90.3, fonksiyon skoru 91.5 olarak bulunmuştur. VakalanmlZ/n diz skoruna göre %97.2'si,fonksiyon sokuna göre ise %86.1 'i çok iyi ve iyi grubunda yer almaktadır. Komplikasyon olarak i dizde infeksiyon 2 hastada da geçici peroneral sinir paralizi gözlenmiştir. Sonuç olarak romatoid artritli hastalarda total diz artroplastisi uygulamalarında yüksek infeksiyon oranı, yetersiz kemik kalitesi, yumuşak doku dengesini kurmaktaki zorluklar, multiple eklem tutulumu ve hastanm yetersiz immobilizasyonu gibi pekçok zorlukla mücadele edilmesi gerekmektedir. Ancak bu hastalarda ağrının giderilmesi ve fonksiyonlann tekrar kazanılmasmda total diz artroplasıisi halen rakipsiz bir yöntem olarak devam etmektedir.

Anahtar Kelimeler

• -