Managements In Rheumatoid Arthritis Combined With Osteoarthritis Undergoing Total Knee Arthroplasty

Objective To investigate the perioperative managements, surgical technique and clinical results of total knee replacement (TKR) in patients with knee rheumatoid arthritis and osteoarthritis.Methods Between January 2006 and September 2009,14 TKRs were performed on 10 patients with rheumatoid arthritis combined with osteoarthritis by a single surgeon.The diagnosis are based on criteria presented by American College of Rheumatology (ACR) and Chinese Medical Association (CMA).The diagnosis of OA is made both clinically and radiographically.Three patients were male and seven patients were female.The average age at the time of operation was 58 years (range,55-64 years). Four cases are both knee involved and the TKRs are performed in one surgery.All of them have knee replacement indications.The surgeries adopted medial parapatellar approach, synovial cleaning,inactivating synovium,standard osteotomy and appropriate soft tissue release with posterior stabilized implants.Intravenous antibiotic therapy went on 1 week after surgery, or suspend until the body temperature drops to normal levels one day.Results All patients were followed up for for 3 to 36 months.The patients were evaluated according to HSS, and the complications were observed. After a mean follow-up of 10 months (range,3 months-36 months), the average HSS improved from 30 points(range,19-37 points) preoperatively to 78 points (range, 75-83 points) postoperatively. ROM (range of motion) improved from 70°(range,60°-90°) preoperatively to 110°(range,90°-120°) postoperatively. One knee incision had healing problem. One knee had lightly instability at follow-up, no other complications occurred.Conclusions The techniques of medial parapatellar approach, synovial cleaning, inactivating synovium, standard osteotomy and appropriate soft tissue release, posterior stabilized implants, intravenous antibiotic therapy, management of complications can provides excellent results very successfully in patients with knee rheumatoid arthritis and osteoarthritis undergoing primary total knee replacement.