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Published in: Journal of Orthopaedic Surgery and Research 1/2013

Open Access 01-12-2013 | Research article

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

Authors: Denglu Yan, Jing Yang, Fuxing Pei

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2013

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Abstract

Background

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.

Methods

This 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).

Results

There 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.

Conclusions

TKA 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.
Appendix
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Literature
1.
go back to reference Kajino A, Yoshino S, Kameyama S, Kohda M, Nagashima S: Comparison of the results of bilateral total knee arthroplasty with and without patellar replacement for rheumatoid arthritis - a follow-up note. J Bone Joint Surg Am. 1997, 79A (4): 570-574. Kajino A, Yoshino S, Kameyama S, Kohda M, Nagashima S: Comparison of the results of bilateral total knee arthroplasty with and without patellar replacement for rheumatoid arthritis - a follow-up note. J Bone Joint Surg Am. 1997, 79A (4): 570-574.
2.
go back to reference Aglietti P, Windsor RE, Buzzi R, Insall JN: Arthroplasty for the stiff or ankylosed knee. J Arthroplasty. 1989, 4 (1): 1-5. 10.1016/S0883-5403(89)80046-4.CrossRefPubMed Aglietti P, Windsor RE, Buzzi R, Insall JN: Arthroplasty for the stiff or ankylosed knee. J Arthroplasty. 1989, 4 (1): 1-5. 10.1016/S0883-5403(89)80046-4.CrossRefPubMed
3.
go back to reference Chmell MJ, Scott RD: Total knee arthroplasty in patients with rheumatoid arthritis. An overview. Clin Orthop Relat Res. 1999, 366: 54-60.CrossRefPubMed Chmell MJ, Scott RD: Total knee arthroplasty in patients with rheumatoid arthritis. An overview. Clin Orthop Relat Res. 1999, 366: 54-60.CrossRefPubMed
4.
go back to reference Tew M, Forster IW: Effect of knee replacement on flexion deformity. J Bone Joint Surg Br. 1987, 69 (3): 395-399.PubMed Tew M, Forster IW: Effect of knee replacement on flexion deformity. J Bone Joint Surg Br. 1987, 69 (3): 395-399.PubMed
5.
go back to reference McPherson EJ, Cushner FD, Schiff CF, Friedman RJ: Natural history of uncorrected flexion contractures following total knee arthroplasty. J Arthroplasty. 1994, 9 (5): 499-502. 10.1016/0883-5403(94)90096-5.CrossRefPubMed McPherson EJ, Cushner FD, Schiff CF, Friedman RJ: Natural history of uncorrected flexion contractures following total knee arthroplasty. J Arthroplasty. 1994, 9 (5): 499-502. 10.1016/0883-5403(94)90096-5.CrossRefPubMed
6.
go back to reference Firestone TP, Krackow KA, Davis JD, Teeny SM, Hungerford DS: The management of fixed flexion contractures during total knee arthroplasty. Clin Orthop Relat Res. 1992, 284: 221-227.PubMed Firestone TP, Krackow KA, Davis JD, Teeny SM, Hungerford DS: The management of fixed flexion contractures during total knee arthroplasty. Clin Orthop Relat Res. 1992, 284: 221-227.PubMed
7.
go back to reference McGrath MS, Mont MA, Siddiqui JA, Baker E, Bhave A: Evaluation of a custom device for the treatment of flexion contractures after total knee arthroplasty. Clin Orthop Relat Res. 2009, 467 (6): 1485-1492. 10.1007/s11999-009-0804-z.PubMedCentralCrossRefPubMed McGrath MS, Mont MA, Siddiqui JA, Baker E, Bhave A: Evaluation of a custom device for the treatment of flexion contractures after total knee arthroplasty. Clin Orthop Relat Res. 2009, 467 (6): 1485-1492. 10.1007/s11999-009-0804-z.PubMedCentralCrossRefPubMed
8.
go back to reference Abe S, Kohyama K, Yokoyama H, Shigeru M, Yasuhiro T, Natsuko N, Yasuhiro S, Hiroyuki F: Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases. Mod Rheumatol. 2008, 18 (5): 499-506. 10.1007/s10165-008-0079-3.CrossRefPubMed Abe S, Kohyama K, Yokoyama H, Shigeru M, Yasuhiro T, Natsuko N, Yasuhiro S, Hiroyuki F: Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases. Mod Rheumatol. 2008, 18 (5): 499-506. 10.1007/s10165-008-0079-3.CrossRefPubMed
9.
go back to reference Massin P, Petit A, Odri G, Ducellier F, Sabatier C, Lautridou C, Cappelli M, Hulet C, Canciani JP, Letenneur J, Burdin P, Société d'orthopédie de l'oues: Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Orthop Traumatol Surg Res. 2009, 95 (4 Suppl 1): S7-S12.CrossRefPubMed Massin P, Petit A, Odri G, Ducellier F, Sabatier C, Lautridou C, Cappelli M, Hulet C, Canciani JP, Letenneur J, Burdin P, Société d'orthopédie de l'oues: Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Orthop Traumatol Surg Res. 2009, 95 (4 Suppl 1): S7-S12.CrossRefPubMed
10.
go back to reference Sarokhan AJ, Scott RD, Thomas WH, Sledge CB, Ewald FC, Cloos DW: Total knee arthroplasty in juvenile rheumatoid arthritis. J Bone Joint Surg Am. 1983, 65 (8): 1071-1080.PubMed Sarokhan AJ, Scott RD, Thomas WH, Sledge CB, Ewald FC, Cloos DW: Total knee arthroplasty in juvenile rheumatoid arthritis. J Bone Joint Surg Am. 1983, 65 (8): 1071-1080.PubMed
11.
go back to reference Ito J, Koshino T, Okamoto R, Saito T: 15-year follow-up study of total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty. 2003, 18 (8): 984-992. 10.1016/S0883-5403(03)00262-6.CrossRefPubMed Ito J, Koshino T, Okamoto R, Saito T: 15-year follow-up study of total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty. 2003, 18 (8): 984-992. 10.1016/S0883-5403(03)00262-6.CrossRefPubMed
12.
go back to reference Atilla B, Caglar O, Pekmezci M, Buyukasik Y, Tokgozoglu AM, Alpaslan M: Pre-operative flexion contracture determines the functional outcome of haemophilic arthropathy treated with total knee arthroplasty. Haemophilia. 2012, 18 (3): 358-363. 10.1111/j.1365-2516.2011.02695.x.CrossRefPubMed Atilla B, Caglar O, Pekmezci M, Buyukasik Y, Tokgozoglu AM, Alpaslan M: Pre-operative flexion contracture determines the functional outcome of haemophilic arthropathy treated with total knee arthroplasty. Haemophilia. 2012, 18 (3): 358-363. 10.1111/j.1365-2516.2011.02695.x.CrossRefPubMed
13.
go back to reference Mitsuyasu H, Matsuda S, Miura H, Okazaki K, Fukagawa S, Iwamoto Y: Flexion contracture persists if the contracture is more than 15 degrees at 3 months after total knee arthroplasty. J Arthroplasty. 2011, 26 (4): 639-643. 10.1016/j.arth.2010.04.023.CrossRefPubMed Mitsuyasu H, Matsuda S, Miura H, Okazaki K, Fukagawa S, Iwamoto Y: Flexion contracture persists if the contracture is more than 15 degrees at 3 months after total knee arthroplasty. J Arthroplasty. 2011, 26 (4): 639-643. 10.1016/j.arth.2010.04.023.CrossRefPubMed
14.
go back to reference Cheng K, Ridley D, Bird J, McLeod G: Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without: ten-year prospective data. Int Orthop. 2010, 34 (5): 663-667. 10.1007/s00264-009-0801-6.PubMedCentralCrossRefPubMed Cheng K, Ridley D, Bird J, McLeod G: Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without: ten-year prospective data. Int Orthop. 2010, 34 (5): 663-667. 10.1007/s00264-009-0801-6.PubMedCentralCrossRefPubMed
15.
go back to reference Koshino T, Okamoto R, Takagi T, Yamamoto K, Saito T: Cemented ceramic YMCK total knee arthroplasty in patients with severe rheumatoid arthritis. J Arthroplasty. 2002, 17 (8): 1009-1015. 10.1054/arth.2002.35826.CrossRefPubMed Koshino T, Okamoto R, Takagi T, Yamamoto K, Saito T: Cemented ceramic YMCK total knee arthroplasty in patients with severe rheumatoid arthritis. J Arthroplasty. 2002, 17 (8): 1009-1015. 10.1054/arth.2002.35826.CrossRefPubMed
16.
go back to reference Berend KR, Lombardi AV, Adams JB: Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Clin Orthop Relat Res. 2006, 452: 83-87.CrossRefPubMed Berend KR, Lombardi AV, Adams JB: Total knee arthroplasty in patients with greater than 20 degrees flexion contracture. Clin Orthop Relat Res. 2006, 452: 83-87.CrossRefPubMed
17.
go back to reference Goudie ST, Deakin AH, Ahmad A, Maheshwari R, Picard F: Flexion contracture following primary total knee arthroplasty: risk factors and outcomes. Orthop. 2011, 34 (12): e855-e859. Goudie ST, Deakin AH, Ahmad A, Maheshwari R, Picard F: Flexion contracture following primary total knee arthroplasty: risk factors and outcomes. Orthop. 2011, 34 (12): e855-e859.
18.
go back to reference Quah C, Swamy G, Lewis J, Kendrew J, Badhe N: Fixed flexion deformity following total knee arthroplasty. A prospective study of the natural history. Knee. 2012, 19 (5): 519-521. 10.1016/j.knee.2011.09.003.CrossRefPubMed Quah C, Swamy G, Lewis J, Kendrew J, Badhe N: Fixed flexion deformity following total knee arthroplasty. A prospective study of the natural history. Knee. 2012, 19 (5): 519-521. 10.1016/j.knee.2011.09.003.CrossRefPubMed
19.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN: Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989, 248: 13-14.PubMed Insall JN, Dorr LD, Scott RD, Scott WN: Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989, 248: 13-14.PubMed
20.
go back to reference Tanzer M, Miller J: The natural history of flexion contracture in total knee arthroplasty. A prospective study. Clin Orthop Relat Res. 1989, 248: 129-134.PubMed Tanzer M, Miller J: The natural history of flexion contracture in total knee arthroplasty. A prospective study. Clin Orthop Relat Res. 1989, 248: 129-134.PubMed
21.
go back to reference Ojima T, Yokogawa A, Yamakado K, Ogawa K, Kobayashi T, Nakashima A, Ogawa H: Bilateral total knee arthroplasty after spontaneous osseous ankylosis in rheumatoid arthritis. Mod Rheumatol. 2005, 15 (2): 139-143. 10.1007/s10165-005-0380-3.CrossRefPubMed Ojima T, Yokogawa A, Yamakado K, Ogawa K, Kobayashi T, Nakashima A, Ogawa H: Bilateral total knee arthroplasty after spontaneous osseous ankylosis in rheumatoid arthritis. Mod Rheumatol. 2005, 15 (2): 139-143. 10.1007/s10165-005-0380-3.CrossRefPubMed
22.
go back to reference Smilowicz M, Jung L: Total knee arthroplasty in patients with severe deformities due to rheumatoid arthritis. Ortop Traumatol Rehabil. 2005, 7 (6): 673-679.PubMed Smilowicz M, Jung L: Total knee arthroplasty in patients with severe deformities due to rheumatoid arthritis. Ortop Traumatol Rehabil. 2005, 7 (6): 673-679.PubMed
23.
go back to reference Whiteside LA: Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res. 1999, 367: 130-140.CrossRefPubMed Whiteside LA: Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res. 1999, 367: 130-140.CrossRefPubMed
24.
go back to reference Kim JM, Moon MS: Squatting following total knee arthroplasty. Clin Orthop Relat Res. 1995, 313: 177-186.PubMed Kim JM, Moon MS: Squatting following total knee arthroplasty. Clin Orthop Relat Res. 1995, 313: 177-186.PubMed
25.
go back to reference Laskin RS, O’Flynn HM: The Insall Award. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications. Clin Orthop Relat Res. 1997, 345: 24-28.CrossRefPubMed Laskin RS, O’Flynn HM: The Insall Award. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications. Clin Orthop Relat Res. 1997, 345: 24-28.CrossRefPubMed
26.
go back to reference McAuley JP, Engh GA: Constraint in total knee arthroplasty: when and what?. J Arthroplasty. 2003, 18 (3 Suppl 1): 51-54.CrossRefPubMed McAuley JP, Engh GA: Constraint in total knee arthroplasty: when and what?. J Arthroplasty. 2003, 18 (3 Suppl 1): 51-54.CrossRefPubMed
27.
go back to reference Scuderi GR, Kochhar T: Management of flexion contracture in total knee arthroplasty. J Arthroplasty. 2007, 22 (4 Suppl 1): 20-24.CrossRefPubMed Scuderi GR, Kochhar T: Management of flexion contracture in total knee arthroplasty. J Arthroplasty. 2007, 22 (4 Suppl 1): 20-24.CrossRefPubMed
28.
go back to reference Meftah M, Blum YC, Raja D, Ranawat AS, Ranawat CS: Correcting fixed varus deformity with flexion contracture during total knee arthroplasty: the “inside-out” technique: AAOS exhibit selection. J Bone Joint Surg Am. 2012, 94 (10): e66-CrossRefPubMed Meftah M, Blum YC, Raja D, Ranawat AS, Ranawat CS: Correcting fixed varus deformity with flexion contracture during total knee arthroplasty: the “inside-out” technique: AAOS exhibit selection. J Bone Joint Surg Am. 2012, 94 (10): e66-CrossRefPubMed
29.
go back to reference Knutson K, Leden I, Sturfelt G, Rosen I, Lidgren L: Nerve palsy after knee arthroplasty in patients with rheumatoid arthritis. Scand J Rheumatol. 1983, 12 (3): 201-205. 10.3109/03009748309098533.CrossRefPubMed Knutson K, Leden I, Sturfelt G, Rosen I, Lidgren L: Nerve palsy after knee arthroplasty in patients with rheumatoid arthritis. Scand J Rheumatol. 1983, 12 (3): 201-205. 10.3109/03009748309098533.CrossRefPubMed
30.
go back to reference Omeroglu H, Ozcelik A, Turgut A: Bilateral peroneal nerve palsy after simultaneous bilateral total knee arthroplasty. Report of a case with rheumatoid arthritis. Knee Surg Sports Traumatol Arthrosc. 2001, 9 (4): 225-227. 10.1007/s001670100211.CrossRefPubMed Omeroglu H, Ozcelik A, Turgut A: Bilateral peroneal nerve palsy after simultaneous bilateral total knee arthroplasty. Report of a case with rheumatoid arthritis. Knee Surg Sports Traumatol Arthrosc. 2001, 9 (4): 225-227. 10.1007/s001670100211.CrossRefPubMed
31.
go back to reference Lu H, Mehdi G, Zhou D, Lin J: Simultaneous bilateral total knee arthroplasty for rheumatoid arthritis. Chin Med J (Engl). 1996, 109 (12): 937-940. Lu H, Mehdi G, Zhou D, Lin J: Simultaneous bilateral total knee arthroplasty for rheumatoid arthritis. Chin Med J (Engl). 1996, 109 (12): 937-940.
32.
go back to reference Figgie HE, Brody GA, Inglis AE, Sculco TP, Goldberg VM, Figgie MP: Knee arthrodesis following total knee arthroplasty in rheumatoid arthritis. Clin Orthop Relat Res. 1987, 224: 237-243.PubMed Figgie HE, Brody GA, Inglis AE, Sculco TP, Goldberg VM, Figgie MP: Knee arthrodesis following total knee arthroplasty in rheumatoid arthritis. Clin Orthop Relat Res. 1987, 224: 237-243.PubMed
33.
go back to reference Papotto BA, Mills T: Treatment of severe flexion deficits following total knee arthroplasty: a randomized clinical trial. Orthop Nurs. 2012, 31 (1): 29-34. 10.1097/NOR.0b013e3182419662.CrossRefPubMed Papotto BA, Mills T: Treatment of severe flexion deficits following total knee arthroplasty: a randomized clinical trial. Orthop Nurs. 2012, 31 (1): 29-34. 10.1097/NOR.0b013e3182419662.CrossRefPubMed
34.
go back to reference Smilowicz M: Problems involved in total knee arthroplasty for rheumatoid arthritis patients. Ortop Traumatol Rehabil. 2000, 2 (4): 27-31.PubMed Smilowicz M: Problems involved in total knee arthroplasty for rheumatoid arthritis patients. Ortop Traumatol Rehabil. 2000, 2 (4): 27-31.PubMed
35.
go back to reference Rand JA, Ilstrup DM: Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am Vol. 1991, 73 (3): 397-409. Rand JA, Ilstrup DM: Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am Vol. 1991, 73 (3): 397-409.
36.
go back to reference Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB: Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res. 1984, 182: 117-126.PubMed Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB: Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res. 1984, 182: 117-126.PubMed
37.
go back to reference Wilson MG, Kelley K, Thornhill TS: Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am. 1990, 72 (6): 878-883.PubMed Wilson MG, Kelley K, Thornhill TS: Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am. 1990, 72 (6): 878-883.PubMed
Metadata
Title
Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture
Authors
Denglu Yan
Jing Yang
Fuxing Pei
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2013
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-8-41

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