MANAGEMENT OF KNEE RHEUMATOID ARTHRITIS WITH TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW

Total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) has different features from those seen in patients with osteoarthritis. In 1970 85% of the patients undergoing TKA had rheumatoid arthritis. Nowadays less than 5% of the patients undergoing TKA have rheumatoid disease. An important reason for the marked decrease is the improvement of the medical treatment. Fewer patients now progress to permanent structural damage requiring arthroplasty. TKA in RA has management difficulties that are unique to the disease. These include ipsilateral hip involvement, bilaterality, anticoagulation needs, flexion contractures, rheumatoid cysts and possibly the need for synovectomy. Patients with rheumatoid arthritis are more vulnerable to both early and late infections. They require a prosthesis and technique that provide adequate flexion for activities of daily living. Their often-profound osteopenia can lead to intraoperative and postoperative fractures. Finally, their cervical spine and temporal-mandibular disease create challenging anesthetic considerations. Nevertheless, given these considerations and the degree of preoperative disability suffered by patients with rheumatoid arthritis, the results of surgery can be extremely dramatic and gratifying to both patient and surgeon.