Total Knee Replacement In Rheumatoid Arthritis Research Articles

Functional outcome of total knee replacement for inflammatory arthritis of knee

Introduction: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder that involves symmetrical small and large joints. Despite DMARDs, biological agents and anti-inflammatory agents, severe damage to the joint cartilage occurs, mainly due to the growing synovium. Total knee replacement in RA has been an enormous boon to those who are suffering from pain and deformity because of severe restriction of knee joint movement. Objectives: To evaluate the clinical, functional and radiological outcomes after TKR for inflammatory arthropathy and to identify potential factors that affect the functional outcome after TKR for Rheumatoid Arthritis. Materials and Methods: Patients who underwent total knee arthroplasty for rheumatoid arthritis during the period 2011–2018 were recruited for the study after informed consent. The American Knee Society scores and functional scores were used for the functional outcome and assessment. Preoperative scores were obtained from previous medical records. Paired t test was done to determine the significance in changes between the preoperative and postoperative scores. Bivariate analysis using Spearman correlation and logistic regression analysis was performed to assess the influence of various factors on the postoperative knee scores. Results: The average age of patients at the time of TKR was 54 years, all were in stage IV disease, and the majority were women (n = 20). The significant improvement (p = 0.000) was observed between the preoperative (57.3) and postoperative (97.4) Knee Society scores, as well as improvement in functional scores from 36.3 preoperative to 85.2 points postoperatively after TKR. Steroid usage had a significant positive correlation. The duration of disease and involvement of the other joint had a significant negative correlation to postoperative functional scores. Conclusion: Total Knee Replacement has been proved as one of the most successful surgical interventions for reducing pain and enhancing physical function in inflammatory arthritis patients.

Fewer and older patients with rheumatoid arthritis need total knee replacement

Objectives: Recent studies have suggested a decreased need for orthopaedic surgery in patients with rheumatoid arthritis (RA). We analysed trends in total knee replacement (TKR) in RA using TKR in osteoarthritis (OA) as a point of reference.Methods: Data on TKRs from the Finnish Arthroplasty Register and population data from Statistics Finland were used to analyse the trends in TKRs among patients aged ≥ 40 years with primary osteoarthritis (OA) or RA in Finland for the period from 1980 to 2010.Results: During 1980–2010, the overall incidence of TKRs increased 20-fold from 14.2 to 305.3 operations per 105 person-years. After peaking in 1992, the annual incidence of TKRs for RA decreased gradually from 19.6 to 10.8 per 105 [incidence rate ratio (IRR) 0.97, p < 0.001]. The decrease was more pronounced in women and the older (≥ 60 years) age group. The mean age at the time of TKR among patients with RA increased over time, converging with that of patients with OA.Conclusion: There is a clear decrease in the annual incidence of TKRs in RA, while among OA patients the incidence is increasing steadily. Furthermore, patients with RA seem to receive their TKRs at an older age. Both of these findings suggest improving long-term outcome in RA.