Revision Total Knee Arthroplasty for Aseptic and Septic Causes in Patients with Rheumatoid Arthritis

Garcia, Ryan; Hardy, Brian T.; Kraay, Matthew J.; Goldberg, Victor M.

doi:10.1007/s11999-009-1061-x

Cited by 27 publications

(10 citation statements)

References 19 publications

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“…There are limited data regarding the optimal treatment of PJI in patients with IJD. A recent retrospective review of revision TKA in patients with RA describes the outcomes of 18 cases of subacute and chronic PJI [12]. Of the 12 patients who received a two-stage revision, five of them subsequently died within 6 months, while three went on to have failures secondary to reinfection at a mean of 39.6 months.…”

Section: Resultsmentioning

confidence: 99%

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: a Review of Risk Factors and Current Approaches to Diagnosis and Management

et al. 2013

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Section: Resultsmentioning

confidence: 99%

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: a Review of Risk Factors and Current Approaches to Diagnosis and Management

et al. 2013

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“…Garcia et al report a survival for all knees (27 mechanical failures and 18 infected revisions) of 76% at 5 years. They also, more worryingly, report a 34 % mortality rate at 6 months for RA patients revised for infection [ 41 ].…”

Section: Revision Arthroplasty Surgerymentioning

confidence: 99%

Lower limb joint replacement in rheumatoid arthritis

Clement

Breusch

Biant

2012

Journal of Orthopaedic Surgery and Research

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IntroductionThere 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.MethodsWe 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’.FindingsThe 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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“…It is shown that the implant survival rates in patients with inflammatory arthritis are less than those for uncomplicated degenerative osteoarthritis disease for several reasons. 19,20 Bourne et al 5 have shown that a sizable percentage (19%) of patients remain dissatisfied after TKA surgery. Tremendous advances have been made in the implant designs, refinement of the surgical treatment of TKR, and patient selection.…”

Section: Discussionmentioning

confidence: 99%

Discrepant histological diagnoses: A cause of early low FJS-12 score and if untreated, unhappy Total Knee Arthroplasty patient

Londhe

Shah

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Purpose: Total Knee Arthroplasty (TKA) is one of the most successful operations in orthopedics. Still, a sizable percentage of patients (20%) remain dissatisfied after a well-executed TKA. The study aims to examine the excised synovium from the suprapatellar region in osteoarthritic knees during TKA and evaluate the histopathology (HP) report to know whether discrepant diagnoses affect the Forgotten Joint Score-12 at various time intervals. Methods: This is a prospective cohort study. Two hundred (160 female; 40 male) end-stage osteoarthritis patients who underwent primary TKA were studied. An inclusion criterion was patient with end-stage osteoarthritis. Clinically and serologically proven rheumatoid arthritis patients were excluded from the study. The synovium excised during the TKA procedure was sent for the HP examination. The statistical significance was measured with the Chi-square test and two-sample t-test. Results: A total of 184 out of the 200 patients (92%) knee synovium showed HP features of osteoarthritis. The discordant diagnoses and discrepant diagnosis rate was 8% and 7%, respectively, which is statistically significant by Chi-square test (p value < 0.0001 and p value ¼ 0.0001). 14 of the patients (12 F:2 M) showed histological features of inflammatory/rheumatoid arthritis who were treated, two patients (all female) showed HP features of villonodular synovitis. The mean (SD) improvement in FJS-12 at six weeks in the concordant group (25.3 [17.6]) is significantly more than the discrepant group (15.3 [12.5]), p-value 0.0385. Conclusion: 8% of our patients exhibited unexpected results. The study showed a 7% rate of discrepant diagnosis. This discrepant diagnosis if missed and untreated, would have affected the function and longterm survival of the implanted TKA.

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Revision Total Knee Arthroplasty for Aseptic and Septic Causes in Patients with Rheumatoid Arthritis

Cited by 27 publications

References 19 publications

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: a Review of Risk Factors and Current Approaches to Diagnosis and Management

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: a Review of Risk Factors and Current Approaches to Diagnosis and Management

Lower limb joint replacement in rheumatoid arthritis

Discrepant histological diagnoses: A cause of early low FJS-12 score and if untreated, unhappy Total Knee Arthroplasty patient

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