Surgical planning and mid-term effectiveness of four major lower extremity arthroplasties in patients with rheumatoid arthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Bangjie , ZHANG Chengkai , CHEN Hong , WANG Liying , LI Yongshi , ZENG Yi ,  YANG Jing

Orthopedic Research Institue, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

YANG Jing, Email: cd-yangjing@163.com

Keywords：

Rheumatoid arthritis; four major lower extremity arthroplasties; hip joint; knee joint; surgical planning; mid-term effectiveness

DOI：

10.7507/1002-1892.202201041

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Objective To investigate the surgical planning and the mid-term effectiveness of four major lower extremity arthroplasties (4JA) in patients with rheumatoid arthritis (RA). Methods A clinical data of 25 patients with RA, who received 4JA and were followed up more than 3 years between June 2012 and September 2018, was retrospectively analyzed. There were 3 males and 22 females, with an average age of 48.6 years (range, 27-80 years). The body mass index ranged from 16.0 to 28.4 kg/m², with an average of 20.48 kg/m². The duration of RA ranged from 2 to 35 years (median, 21 years). There were 8 cases (12 sides) of knee valgus, 6 cases (12 side) of acetabular retraction, and 5 cases (10 sides) of hip stiffness. Among them, 20 patients underwent hip surgery first, and 5 patients underwent knee surgery first. Hip joint function was evaluated by Harris score, Hip Disability and Osteoarthritis Outcome Score (HOOS), hip range of motion, and Trendelenburg sign; knee joint function was evaluated by American Hospital for Special Surgery (HSS) score, knee range of motion and muscle strength, and a timed up and go (TUG) test was performed at last follow-up. X-ray films were used to observe whether the prosthesis was loose or displaced. Results All 25 patients completed 4JA. Only 1 patient (1 side) had incision infection after operation, 3 patients (3 sides) had proximal femur fractures during operation. All patients were followed up 3.0-8.8 years, with an average of 5.8 years. At last follow-up, the Harris score, HOOS score, and range of motion of flexion, extension, and abduction of the hip joint significantly improved when compared with those before operation, and the patients with positive Trendelenburg sign decreased. The HSS score and range of motion of flexion and extension of the knee joint also significantly improved when compared with those before operation. There were significant differences in all indexes between pre- and post-operation (P<0.05). The muscle strength was grade V. The TUG test ranged from 7.8 to 15.34 seconds (mean,10.79 seconds). X-ray films showed the prosthesis was not loose or displaced. Conclusion When RA patients receive 4JA, adequate preoperative evaluation, rational selection of the timing and sequence of surgery, and maximal restoration of lower limb alignment can achieve good mid-term effectiveness.

Citation： SUN Bangjie, ZHANG Chengkai, CHEN Hong, WANG Liying, LI Yongshi, ZENG Yi, YANG Jing. Surgical planning and mid-term effectiveness of four major lower extremity arthroplasties in patients with rheumatoid arthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 567-572. doi: 10.7507/1002-1892.202201041 Copy

1.	McElwain JP, Sheehan JM. Bilateral hip and knee replacement for rheumatoid arthritis. J Bone Joint Surg (Br), 1985, 67(2): 261-265.
2.	Suman RK, Freeman PA. Bilateral hip and knee replacement in rheumatoid arthritis. J Arthroplasty, 1986, 1(4): 237-240.
3.	McDonald I. Bilateral replacement of the hip and knee in rheumatoid arthritis. J Bone Joint Surg (Br), 1982, 64(4): 465-468.
4.	Mulhall KJ, Saleh KJ, Thompson CA, et al. Results of bilateral combined hip and knee arthroplasty in very young patients with juvenile rheumatoid arthritis. Arch Orthop Trauma Surg, 2008, 128(3): 249-254.
5.	Nilsdotter AK, Isaksson F. Patient relevant outcome 7 years after total hip replacement for OA—a prospective study. BMC Musculoskelet Disord, 2010, 11: 47. doi: 10.1186/1471-2474-11-47.
6.	Nú?ez M, Lozano L, Nú?ez E, et al. Total knee replacement and health-related quality of life: factors influencing long-term outcomes. Arthritis Rheum, 2009, 61(8): 1062-1069.
7.	Walker DJ, Usher K, O’Morchoe M, et al. Outcome from multiple joint replacement surgery to the lower limbs. Br J Rheumatol, 2019, 28(2): 139-142.
8.	Papanikolaou A, Droulias K, Nikolaides A, et al. Results of a single total knee prosthesis compared with multiple joint replacement in the lower limb. Int Orthop, 2000, 24(2): 80-82.
9.	Yoshino S, Fujimori J, Morishige T, et al. Bilateral joint replacement of hip and knee joints in patients with rheumatoid arthritis. Arch Orthop Trauma Surg, 1984, 103(1): 1-4.
10.	Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty, 2010, 25(2): 179-185.
11.	呂厚山, 陳曉欣, 林劍浩, 等. 類風濕性關節炎下肢畸形手術順序選擇的初步經驗. 中華骨科雜志, 1995, 15(8): 483-486.
12.	Tauber C, Itzhak IB, Malkin C. Bone grafting in total hip replacement for acetabular protrusion. A review of 11 operations. Acta Orthop Scand, 1984, 55(5): 507-509.
13.	Zhen P, Li X, Zhou S, et al. Total hip arthroplasty to treat acetabular protrusions secondary to rheumatoid arthritis. J Orthop Surg Res, 2018, 13(1): 92. doi: 10.1186/s13018-018-0809-y.
14.	Kosashvili Y, Backstein D, Safir O, et al. Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg (Br), 2009, 91(7): 870-876.
15.	Chiu KY, Ng TP, Tang WM, et al. Review article: knee flexion after total knee arthroplasty. J Orthop Surg (Hong Kong), 2002, 10(2): 194-202.
16.	Su EP. Fixed flexion deformity and total knee arthroplasty. J Bone Joint Surg (Br), 2012, 94(11 Suppl A): 112-115.
17.	Tew M, Forster IW. Effect of knee replacement on flexion deformity. J Bone Joint Surg (Br), 1987, 69(3): 395-399.
18.	Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity: surgical technique. J Bone Joint Surg (Am), 2005, 87: 271-284.
19.	鐘航, 黃強, 楊靜, 等. 人工全膝關節置換術中滑移截骨矯正重度外翻畸形的療效觀察. 中國修復重建外科雜志, 2016, 30(2): 143-147.
20.	Morgan H, Battista V, Leopold SS. Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg, 2005, 13(8): 515-524.
21.	Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil, 2012, 93(7): 1292-1294.
22.	Morelli I, Maffulli N, Brambilla L, et al. Quadriceps muscle group function and after total knee arthroplasty—asystematic narrative update. British Medical Bulletin, 2021, 137(1): 51-69.

1. McElwain JP, Sheehan JM. Bilateral hip and knee replacement for rheumatoid arthritis. J Bone Joint Surg (Br), 1985, 67(2): 261-265.
2. Suman RK, Freeman PA. Bilateral hip and knee replacement in rheumatoid arthritis. J Arthroplasty, 1986, 1(4): 237-240.
3. McDonald I. Bilateral replacement of the hip and knee in rheumatoid arthritis. J Bone Joint Surg (Br), 1982, 64(4): 465-468.
4. Mulhall KJ, Saleh KJ, Thompson CA, et al. Results of bilateral combined hip and knee arthroplasty in very young patients with juvenile rheumatoid arthritis. Arch Orthop Trauma Surg, 2008, 128(3): 249-254.
5. Nilsdotter AK, Isaksson F. Patient relevant outcome 7 years after total hip replacement for OA—a prospective study. BMC Musculoskelet Disord, 2010, 11: 47. doi: 10.1186/1471-2474-11-47.
6. Nú?ez M, Lozano L, Nú?ez E, et al. Total knee replacement and health-related quality of life: factors influencing long-term outcomes. Arthritis Rheum, 2009, 61(8): 1062-1069.
7. Walker DJ, Usher K, O’Morchoe M, et al. Outcome from multiple joint replacement surgery to the lower limbs. Br J Rheumatol, 2019, 28(2): 139-142.
8. Papanikolaou A, Droulias K, Nikolaides A, et al. Results of a single total knee prosthesis compared with multiple joint replacement in the lower limb. Int Orthop, 2000, 24(2): 80-82.
9. Yoshino S, Fujimori J, Morishige T, et al. Bilateral joint replacement of hip and knee joints in patients with rheumatoid arthritis. Arch Orthop Trauma Surg, 1984, 103(1): 1-4.
10. Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty, 2010, 25(2): 179-185.
11. 呂厚山, 陳曉欣, 林劍浩, 等. 類風濕性關節炎下肢畸形手術順序選擇的初步經驗. 中華骨科雜志, 1995, 15(8): 483-486.
12. Tauber C, Itzhak IB, Malkin C. Bone grafting in total hip replacement for acetabular protrusion. A review of 11 operations. Acta Orthop Scand, 1984, 55(5): 507-509.
13. Zhen P, Li X, Zhou S, et al. Total hip arthroplasty to treat acetabular protrusions secondary to rheumatoid arthritis. J Orthop Surg Res, 2018, 13(1): 92. doi: 10.1186/s13018-018-0809-y.
14. Kosashvili Y, Backstein D, Safir O, et al. Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg (Br), 2009, 91(7): 870-876.
15. Chiu KY, Ng TP, Tang WM, et al. Review article: knee flexion after total knee arthroplasty. J Orthop Surg (Hong Kong), 2002, 10(2): 194-202.
16. Su EP. Fixed flexion deformity and total knee arthroplasty. J Bone Joint Surg (Br), 2012, 94(11 Suppl A): 112-115.
17. Tew M, Forster IW. Effect of knee replacement on flexion deformity. J Bone Joint Surg (Br), 1987, 69(3): 395-399.
18. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity: surgical technique. J Bone Joint Surg (Am), 2005, 87: 271-284.
19. 鐘航, 黃強, 楊靜, 等. 人工全膝關節置換術中滑移截骨矯正重度外翻畸形的療效觀察. 中國修復重建外科雜志, 2016, 30(2): 143-147.
20. Morgan H, Battista V, Leopold SS. Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg, 2005, 13(8): 515-524.
21. Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil, 2012, 93(7): 1292-1294.
22. Morelli I, Maffulli N, Brambilla L, et al. Quadriceps muscle group function and after total knee arthroplasty—asystematic narrative update. British Medical Bulletin, 2021, 137(1): 51-69.

Chinese Journal of Reparative and Reconstructive Surgery

Surgical planning and mid-term effectiveness of four major lower extremity arthroplasties in patients with rheumatoid arthritis

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