The Mid-term Clinical Outcome Of Total Knee Arthroplasty In The Treatment Of Advanced Rheumatoid Arthritis

ObjectiveTo analysis the mid-term clinical outcome and complications of the total kneearthroplasty (TKA) in patients with advanced Rheumatoid Arthritis (RA). And to evaluatethe effects of psychological factors on postoperative function, improvement of pain andsatisfaction rate in patients who suffered from the operation.MethodsThe first part: A retrospective analysis was performed in78patients (112knees) withRA, who have undergone TKA operation during the period of May1999to November2012. The clinical results were evaluated by comparing HSS, KSS, WOMAC, ROM andcomplications. The patients’ health statuses were evaluated by using the Short Form36-item Survey (SF-36).The second part: forty patients (57knees) with RA, who have undergone TKAoperation during the period of November2007to November2012. The clinical resultswere evaluated by comparing KSS. The patients’ psychological statues were evaluated by using SAS (self-rating anxiety scale) and SDS (self-rating depression scale). Toinvestigate the effects of psychological factors on postoperative function, improvement ofpain and satisfaction rate after TKA operation.ResultsThe part one56patients (84knees) were successfully followed up. Significant difference wasobserved in HSS, KSS, SF-36, ROM, WOMAC, SAS and SDS. The average follow-upduration in this study was6.01years (range,2-13years). All functions of knee jointimproved after TKA. The mean value of the scores according to HSS was averageimproved from the preoperative48.06±12.27to the87.38±5.70at the follow-upexamination (P <0.05). The mean value of the scores according to the pain of KSS wasaverage improved from the preoperative19.76±8.06to the48.87±2.73at the follow-upexamination (P <0.05). The mean value of the scores according to the function of KSSwas average improved from the preoperative20.36±16.33to the72.86±16.51at thefollow-up examination (P <0.05). The mean value of the scores based on the SF-36scoresPCS showed an average improvement from26.45±3.57preoperatively to46.66±7.01at follow-up (P <0.05). The MCS showed an average improvement from42.36±5.53preoperatively to52.99±5.61at follow-up (P <0.05). The mean value of the scoresaccording to WOMAC was decreased after TKA (P <0.05). There was1knee sufferedfrom revision surgery with infection, patellar fracture, deep venous thrombosis andwound healing, respectively.The part two36patients (51knees) were successfully followed up. The follow-up duration in thisstudy was ranged from2to13years. The mean value of the scores according to SAS wasaverage decreased from the preoperative55.95±5.27to the39.14±5.11at the follow-upexamination (P <0.05). The mean value of the scores according to SDS was averagedecreased from the preoperative57.20±7.87to the44.36±7.41at the follow-upexamination (P <0.05). Depressive tendencies group compared with the group withoutdepressive tendencies, not only the excellent or good results rate of knee function and pain but also the satisfaction rate of self-assessment satisfaction rate were lower than thelatter(P <0.05).Conclusion1. The mid-term clinical outcome of TKA in the treatment of advanced RA issatisfactory. TKA can significantly improve the quality of life of patients.2. The depression of RA may influence the excellent or good results rate ofpostoperative function, improvement of pain and satisfaction rate in patients who sufferedfrom the operation. It was necessary to pay attention on the psychological aspects in thetreatment of advanced RA.