Knee arthroplasty in rheumatoid arthritis: Four- to Six-year follow-up study

doi:10.1016/S0883-5403(87)80043-8

The Journal of Arthroplasty

Volume 2, Issue 3, 1987, Pages 233-239

https://doi.org/10.1016/S0883-5403(87)80043-8 Get rights and content

Abstract

A consecutive series of total condylar knee arthroplasties in patients with rheumatoid or related arthritis, with a 4–6-year follow-up period, was studied. Eighty-seven percent had an excellent or good overall result (score of 70 or more on the HSS knee rating scale). The median total score increased from 45 points before operation to 83 after operation. Sixteen complications, mostly minor, occurred in 14 patients. There were no early infections. Two prostheses were removed for deep infection, after 3 and 5 years. One patient had patellectomy for avascular necrosis. The crude prosthesis survival rate was 97%. Tibial radiolucencies were noted in 76% of cases; in 29% they were significant (2 mm or more in one or more of three zones). Two tibial components (2%) were believed to be mechanically loose, but no revisions for mechanical loosening were done. The presence of radiolucencies did not signify an inferior clinical result.

References (38)

NielsenS et al.
Total condylar knee arthroplasty: a report of two-year follow-up on 247 cases
Arch Orthop Trauma Surg
(1985)
AhlbäckS
Osteoarthrosis of the knee: a radiographic examination
Acta Radiol
(1968)
AndersenJL
Knee arthroplasty in rheumatoid arthritis
Acta Orthop Scand
(1979)
AndriacchiTP et al.
A study of lower-limb mechanics during stair climbing
J Bone Joint Surg
(1980)
BargrenJH et al.
Alignment in total knee arthroplasty: correlated biomechanical and clinical observations
Clin Orthop
(1983)
BoegårdT et al.
Seventy-four Attenborough knee replacements for rheumatoid arthritis
Acta Orthop Scand
(1984)
EgundN et al.
Medial gonartros: jämförelse mellan röntgenundersökning och iagttagelser under operation
Läkertidn
(1980)
ElvesMW et al.
The effect of indomethacin upon experimental fractures in the rat
Acta Orthop Scand
(1982)
EwaldFC et al.
Kinematic total knee replacement
J Bone Joint Surg
(1984)
GarnerRW et al.
Wound healing after operations on patients with rheumatoid arthritis
J Bone Joint Surg
(1973)

GoodsonJM et al.

Inhibition of fetal bone growth and augmentation of PGE₂ resorptive response by indomethacin

Adv Prostaglandin Thromboxane Leukotriene Res

(1980)

HungerfordDS et al.

Total joint arthroplasty of the knee

Clin Orthop

(1985)

Hvid I: Trabecular bone strength at the knee. Clin Orthop (in...

HvidI et al.

Subchondral bone strength in arthrosis: cadaver studies of tibial condyles

Acta Orthop Scand

(1986)

HvidI et al.

Total condylar knee arthroplasty: prosthetic component positioning and radiolucent lines

Acta Orthop Scand

(1984)

InsallJN

Total knee replacement

InsallJN et al.

The total condylar knee prosthesis in gonarthrosis: a five to nine-year follow-up of the first one hundred consecutive cases

J Bone Joint Surg

(1983)

InsallJN et al.

The posterior stabilized condylar prosthesis: a modification of the total condylar design—two to four-year clinical experience

J Bone Joint Surg

(1982)

InsallJN et al.

A comparison of four models of total knee-replacement prostheses

J Bone Joint Surg

(1976)

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Fifty-one primary consecutive cementless AGC 2000 (Anatomically Graduated Components, Biomet, Warsaw, IN) total knee arthroplasties were performed during 1985 through 1990 in 40 patients with rheumatoid arthritis. Forty-one knees (32 patients) were available for clinical and radiologic follow-up analysis after 24 to 76 months (median, 54 months). There was no pain in 33 knees and mild pain in the rest. Median range of motion was 110° (range, 50°–130°). Median knee score was 90 (range, 71–97), and all knees were rated good or excellent. Radiolucencies greater than 1 mm were found under five tibial components, but no obvious migrations were seen. One tibial component was revised due to aseptic loosening. The cumulative success rate after 4 to 5 years was 97% (lower limit of 95% confidence interval, 91.8%). The medium-term results are considered to compare favorably with reported cemented series.
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Survivorship analysis was used in the evaluation of 348 consecutive primary total condylar knee arthroplasties (total knee arthroplasties) performed on 253 patients in a 27-month period, with a maximum follow-up period of 12 years. The diagnosis was osteoarthrosis in 184 cases and rheumatoid arthritis in 164 cases. Ten patients (10 total knee arthroplasties) were lost to follow-up evaluation. The endpoint was defined as prosthesis not in situ. The variables considered were age, sex, body mass index, and diagnosis. The overall cumulative survival rate was 92%. The survival rate of the osteoarthrosis group was significantly higher (97%) than that of the rheumatoid arthritis group (87%). None of the other variables affected survival rate significantly.
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¹: From the Orthopaedic Hospital, University of Aarhus, Aarhus, Denmark.

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Knee arthroplasty in rheumatoid arthritis: Four- to Six-year follow-up study

Abstract

Arch Orthop Trauma Surg

Osteoarthrosis of the knee: a radiographic examination

Acta Radiol