Total Knee Replacement in Severly Deformed Rheumatoid Knee: A Case Study

Rheumatoid arthritis is a well known systematic inflammatory disease wherein arthritis of synovial joints is a major component. This disease is common in females and affects during third, fourth and fifth decades of their life. Initially the disease starts with pain and joint stiffness in small joints of hand and later involves big joints like hip, knee, shoulder and elbow. In an advanced rheumatoid arthritis all the joints of the body are involved.

Treatment of rheumatoid arthritis is ideally to be done by rheumatologist. Start with NSAIDS and later go on to combination therapy of DMARDS (steroids, methotrexate, leflunomide, sulfasalazine chloroquine and oral gold salts).

An Orthopedics role comes only after joint pain/ swelling and deformity are not controlled by medical treatment.

Indication of joint replacement in rheumatoid arthritis.

1. Severe pain in joints
2. Inability to do daily activities
3. Progressing deformity
4. Joint stiffness

Advantages of joint replacement

1. Painless and stable joints
2. Good functional movements of joints
3. Improvement in quality of life
4. Better disease control after surgery

With advent of new implants, good operation theatres, laminar flow and surgical expertise, it is possible to perform joint replacements even in severely deformed joints which was thought impossible previously.

Knee Replacement on a patient with severe Rheumatoid Arthritis

A 58 year old female patient consulted us with severe knee pain for four years. She was a known case of rheumatoid arthritis on medical treatment,she was unable to stand or walk and had severe pain on bending the knee.

This lady was poorly nourished and anemic. Local examination of both knees revealed that she has wind-swipe deformity. Right knee was in 30 varus deformity and range of movement was 0-90. Left knee was in 40 valgus and further valgus till 70. Range of movement was 0-30. X-ray of right knee showed severe varus deformity with medical tibial condyle defect and lateral subluxation of tibia. Left knee - severe valgus deformity with central tibial bone defect and lateral patellar subluxation.

Patient was admitted and complete pre-operative work done. The team of Orthopaedic surgeons headed by Dr. Sanjay Pai, Rheumatologist .A total knee replacement was done in a staged manner. First the right knee with varus deformity was operated using a revision total knee replacement implants. After five days, the left knee with severe valgus deformity was operated. Post operative period was uneventful and without complications.

The patient was mobilized on the third day with walker and was discharged on the sixth day. On the 12th day, the patient was able to walk without support, able to climb stairs and do her daily activities.

With Good surgical expertise along with highly efficient support staff now available in India and , these patients can get back their normal daily life style which was thought impossible in the past.

Courtesy: Dr. Sanjay Pai, M.S.
Dr. Srinivas J V, M.S.
Dr. Vasudev N Prabhu, M.S.
Department of Orthopaedic Surgery Wockhardt Hospitals, Bangalore