Abstract
BackgroundThe aim of this study was to evaluate the influence of antirheumatic drug treatment on knee function of stiff knee patients after total knee arthroplasty (TKA).MethodsTwenty-seven patients (44 knees) of active RA (rheumatoid arthritis) or AS (ankylosing spondylitis) with stiff knees were included in this study. And they were divided into two groups according to continue antirheumatic drug treatment or not after TKA: the therapeutic group (16 patients, 27 knees) and the controlled group (11 patients, 17 knees). The outcomes were assessed by Knee Society Score (KSS), Visual Analogue Scale (VAS), range of motion (ROM) (at week 6, month 6, year 1, and year 2), “Forgotten Joint” Scale (FJS), with or without crutch, satisfaction, and revision (at year 2). The knee prosthetic loosening was evaluated by the followed X-ray at each following time.ResultsThe mean follow-up time was 51 months (34–69 months). The KSS was higher at week 6 after TKA in the therapeutic group (p < 0.05); however, the functional scores of KSS at month 6, year 1, and year 2 in the controlled group were more points improved. The therapeutic patients preferred the knee more at month 6, year 1, and year 2. The differences of KSS clinical scores (at month 6, year 1, and year 2), VAS, ROM, Crutch and FJS between the two groups were not statistically significant (p > 0.05).ConclusionFor patients with stiff knees, the sequential antirheumatic drug treatment after TKA had no obvious effect on postoperative KSS, but can improve the satisfaction.Level of evidenceTherapeutic level II. See Instructions for Authors for a complete description of levels of evidence.
Highlights
The amount of flexion achieved after total knee arthroplasty (TKA) is determined by the amount of preoperative flexion, especially if the flexion was less than 50° [1]
Numerous studies have mainly focused on the stiff knee [1]; there may be a tendency to underestimate the outcome for stiff knee with or without sequential drug treatment for rheumatoid and ankylosing spondylitis
The patients were classified into two groups: Group 1 included stiff knees with sequential drug treatment after TKA (3 patients lost to follow-up; 27 knees in 16 patients; bilateral in 11 patients and unilateral in 5 patients), and Group 2 included stiff knees without sequential drug treatment (17 knees in 11 patients; bilateral in 6 patients and unilateral in 5 patients) (Fig. 1)
Summary
The amount of flexion achieved after total knee arthroplasty (TKA) is determined by the amount of preoperative flexion, especially if the flexion was less than 50° [1]. Preoperative restriction of knee motion is a challenge for surgeons [2]. There were some studies regarding results of primary TKAs in patients with a preoperative arc of motion of 50° or less. From these literatures, we knew that the surgical approach in these patients could be a challenge because of difficulty in patellar eversion. The aim of this study was to evaluate the influence of antirheumatic drug treatment on knee function of stiff knee patients after total knee arthroplasty (TKA)
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