Elsevier

The Journal of Arthroplasty

Volume 18, Issue 8, December 2003, Pages 984-992
The Journal of Arthroplasty

15-year follow-up study of total knee arthroplasty in patients with rheumatoid arthritis

https://doi.org/10.1016/S0883-5403(03)00262-6Get rights and content

Abstract

In 25 patients with rheumatoid arthritis, 36 cases of cemented Kinematic total knee arthroplasty were reviewed clinically and radiographically at 13 to 19 years after surgery. The mean age at the time of surgery was 51.6 ± 8.9 years. According to the follow-up results evaluated with the Hospital for Special Surgery knee scoring system, 28 knees (77.7%) were classified as good or excellent. The mean flexion angle at follow-up evaluation was 99° ± 24° (10°–140°). At the tibial or femoral bone-cement interfaces, a radiolucent line was seen in 10 of 36 knees (27.8%) at follow-up evaluation. The survival rate of prostheses with revision as the endpoint was estimated to be 93.7% at 15 years. Kinematic total knee arthroplasty in rheumatoid arthritis patients provided a good long-term outcome.

Section snippets

Materials and methods

From 1981 to 1987, 128 cases of primary total knee arthroplasty with a Kinematic anteriorly joined (AJ) type or posterior cruciate-retention (PCR) were performed in 93 patients with rheumatoid arthritis at our University Hospital and its affiliated hospitals. Cement was used at the insertion of implants. The patella was not resurfaced in any patient at primary surgery except in 3 knees with anterior knee pain and articular deformity in the patellofemoral joint on radiographs.

At follow-up, 38

Clinical evaluation

Knee scores as determined by the HSS score improved from a preoperative mean of 38.6 ± 8.5 points (range, 21–60 points) to 79.3 ± 10.6 points (range, 57–98 points) at the follow-up evaluation (P<.0001, by Wilcoxon signed rank test).

Average KS knee scores improved from a mean of 45.8 ± 13.6 points preoperatively to 88.3 ± 11.2 points at the follow-up evaluation (P<.0001, by Wilcoxon signed rank test). Function as determined by KS score improved from a mean of 11.9 ± 13.6 points preoperatively to

Discussion

In previous reports of TKA in rheumatoid patients, the clinical results were excellent or good in 77% to 81% of patients 6, 7, 11. A prosthesis other than the Kinematic implant was used in these studies. The functional status of rheumatoid patients after TKA remained far below that of patients with osteoarthritis treated with TKA [12]. This was believed to be caused by the polyarticular involvement of rheumatoid arthritis and the steadily declining functional status that can occur in the long

References (27)

  • O. Kristensen et al.

    Long-term results of total condylar knee arthroplasty in rheumatoid arthritis

    J Bone Joint Surg Am

    (1992)
  • R.S. Laskin

    Total condylar knee replacement in patients who have rheumatoid arthritisa ten-year follow-up study

    J Bone Joint Surg Am

    (1990)
  • C.S. Ranawat et al.

    Long-term results of the total condylar knee arthroplastya 15-year survivorship study

    Clin Orthop

    (1993)
  • Cited by (44)

    • Long-term outcomes and duration of outdoor ambulation following primary total knee arthroplasty in patients with rheumatoid arthritis

      2022, Journal of Orthopaedic Science
      Citation Excerpt :

      TKA would be more useful if walking function was preserved long term. The cumulative survival rate of TKA prostheses in patients with RA reportedly ranges from 80% to 100% [1–10,21–26]; the main reasons for revision are mechanical loosening, infection, and wear. In this study, the survival rate of TKA implants was 96.6% at 15 years.

    • Mid-term survivorship of Mini-keel™ versus Standard keel in total knee replacements: Differences in the rate of revision for aseptic loosening

      2016, Orthopaedics and Traumatology: Surgery and Research
      Citation Excerpt :

      Total knee arthroscopy (TKA) is a reliable and reproducible procedure with an estimated rate of survival of more than 90% after 15 years of follow-up [1–6].

    • Rehabilitation and Total Joint Arthroplasty

      2012, Clinics in Geriatric Medicine
      Citation Excerpt :

      Primary (first time) procedures are associated with fewer perioperative complications and readmissions and greater functional recovery than revision surgeries.27 Patients with inflammatory arthritis such as rheumatoid arthritis have greater complication rates and less favorable outcomes than those with OA,28 although they too experience marked benefits with TJA surgery.29 This article focuses on primary TJA for OA.

    View all citing articles on Scopus

    No benefits or funds were received in support of this study.

    View full text