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Review
. 2012 Jun 14:7:27.
doi: 10.1186/1749-799X-7-27.

Lower limb joint replacement in rheumatoid arthritis

Nicholas D Clement  1 , Stephen J Breusch, Leela C Biant
Affiliations
Review

Lower limb joint replacement in rheumatoid arthritis

Nicholas D Clement et al. J Orthop Surg Res. .

Abstract

Introduction: There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis.

Methods: We performed a search of the medical literature, using the PubMed search engine (http://www.pubmed.gov). We used the following terms: 'rheumatoid' 'replacement' 'arthroplasty' and 'outcome'.

Findings: The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome.

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Figures

Figure 1
Figure 1
Grade II protrusio acetabuli (A) in a female that underwent THR with medial bone graft and restoration of the center of rotation (B).
Figure 2
Figure 2
Grade III protrusio acetabuli (A) with cage augmentation and medial bone graft (B).
Figure 3
Figure 3
Valgus deformity of knee (A) due to avascular necrosis and bone destruction (B).
Figure 4
Figure 4
Significant valgus deformity and concomitant medial collateral attenuation (A) managed with a rotating hinge TKR (B).
See this image and copyright information in PMC

References

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