Total knee arthroplasty considerations in rheumatoid arthritis

Abstract

The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success.

Figure 1

Posteroanterior radiographic view of bilateral knees demonstrating advanced arthritis. Note the valgus alignment to both legs. RA and OA radiographs differ in that RA radiographs will show periarticular erosions and osteopenia, whereas periarticular osteophytes, subchondral sclerosis, and joint space narrowing are more common in OA.

Figure 2

Lateral radiograph of the right knee. A small effusion is present as well.

Figure 3

The same patient from Figures 1–3, now 22 months after right TKA was performed. The PA radiographs are seen with improved joint alignment in the right knee. The patient is doing well, walking without pain in the right knee, and is now being considered for a left TKA.

Figure 4

Lateral view of the right knee 22 months after TKA.