Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture

Denglu Yan,Jing Yang,Fuxing Pei

doi:10.1186/1749-799x-8-41

Abstract

BackgroundThis study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee.MethodsThis retrospective study reviewed flexion contracture deformity of RA patients who underwent primary TKA and ligament and soft tissue balancing. Based on the flexion contracture deformity, the remaining 76 patients available for analysis were divided into two groups, i.e., severe flexion group (SF) and moderate flexion group (MF).ResultsThere were no intraoperative complications in this study. All patients had improved Knee Society Rating System scores and range of motion. The flexion contracture was completely corrected in MF and SF patients. There were no cases of patellar dislocation, but three cases had mild mediolateral instability in severe flexion group. Four knees (two knees in SF versus two knees in MF) had transient peroneal nerve palsy but recovered after conservative therapy.ConclusionsTKA can be performed successfully in the RA knees with severe flexion contracture. It is very important in TKA to maintain the joint stability in the condition of severe flexion contracture deformity of the RA knee.

Highlights

Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by synovial hyperplasia and resulting joint destruction
Progressive destruction of joints leads to the occurrence of flexion contracture in both of their knees and these patients are deprived of ambulation for long periods of time [2-4]
The purpose of this paper was to report our experience on rheumatoid arthritis (RA) knees with severe flexion contractures performed with one-stage total knee arthroplasty (TKA)

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by synovial hyperplasia and resulting joint destruction. For RA patients, bone cuts have to be performed according to the anatomy and implant design and appropriate ligament balancing is required It is potentially a poor strategy, as more bony cuts are needed to get the knee straight in the operation of RA patients with severe flexion contracture, which creates more problems with respect to instability thereby causing pain and dysfunction [8,9]. Proper soft tissue balancing was very important in TKA for RA patients with flexion contracture and valgus deformity, which do achieve an obvious correction of the flexion contracture and effectively improve the range of motion and the functional recovery of the knee joint after TKA [11]. This study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee

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Discussion

Conclusion