Revisionsarthroplastik des Kniegelenkes bei Patienten mit rheumatoider Arthritis

Abstract

This study aims at reviewing and analysing the experience we collected with revision hinge prosthesis of the knee for aseptic failure in rheumatoid arthritis patients. This is a report on 27 patients suffering from rheumatoid arthritis whose primary knee prosthesis failed due to aseptic loosening. Average implant survivorship amounted to 6.8 years (2-15 years). The patients' age at revision ranged from 56 to 82 years(Ø 70.1 years). In 19 cases (70.4%) the same implant type was repeatedly used. Otherwise, 7 primary resurfacing (25.9%) and 1 hinge prosthesis (3.7%) were replaced either by St. Georg, Guepar or Wallidus implants. At an average of 8.4 years later (1 -25 years), the concerned patients were reinvestigated according to the ''Knee Society Clinical Rating System'' and the ''Knee Society Roentgenographic System''. Results were compared with the corresponding values prior to revision. Complications and revised implant survivorship were reported chronologically. In 85% of the knees, improved ''Knee Society''-values could be scored. The average preoperative knee scores amounted to 52 and functional score was 31. Postoperatively, the corresponding values were 91 and 72, respectively. Progression of radiolucencies was negligible in all cases and all arthroplasties showed a thin sclerotic rim around the bone implant interface. Complication rate immediately after operation amounted to 14.8%. In none of the cases repeated revision had become necessary. Revision knee arthroplasty showed a 85% incidence of improved findings at an average of 8.4 years after implantation. The early complication rate of 14.8% did not influence operation success in the long run, so that the use of hinge knee prostheses in patients with rheumatoid arthritis is recommendable.